Application For Accreditation Of Continuing Legal Education Activity Kba Form 1
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1KBA Form 1
KY Bar Association, CLE Commission, 514 West Main Street, Frankfort, KY 40601-1883
Phone (502) 564-3795 FAX (502) 564-3225
(March 2015 )
APPLICATION FOR ACCREDITATION OF CONTINUING LEGAL EDUCATION ACTIVITY
Program sponsor only: if application is not submitted 30 days prior to the CLE activity, late fees will apply
See SCR 3.650 and 3.660 – Qualifying Continuing Education Activities, Standards, and Procedure for Accreditation
Name and address of organization providing or sponsoring the activity (Not the name of the person applying):
1.
_____________________________________________________________________________________
_____________________________________________________________________________________
Telephone number of provider/sponsor: ________________________________________________________
2.
Title of educational activity: __________________________________________________________________
3.
Date of activity: ___________________________________________________________________________
4.
Location of activity: ________________________________________________________________________
5.
Registration Fee: $ ________________________________________________________________________
6.
Method of presentation or transmission:
7.
□
Live (A “live” program takes place at a specific time and includes the opportunity to interact with or question the
instructor. A video replay with a qualified attorney-facilitator, webcasts, and teleconferences are all “live” programs).
□
Technological (A “technological” program is pre-recorded, available on demand, with no live interaction,)
WRITTEN MATERIALS MUST BE AVAILABLE to participants at the program in order to qualify for CLE accreditation.
8.
Description of materials (required):
□
□
□
□
Total number of pages: ________
Looseleaf
Bound
Electronic
No materials available
□
□
Materials to be distributed:
Before program
At program
(ONLY send complete set of materials if requested by the CLE Commission after receipt of application)
Complete this section ONLY if an “in-house activity” (See SCR 3.600(9) and 3.650(2)(l) to determine applicability):
9.
a.
Outsiders are ______% of faculty (must be at least 50% to qualify for accreditation)
□
□
□
Method of program evaluation:
Participant/attendee critique/evaluation form
Independent evaluator
None
10.
REQUIRED ATTACHMENTS TO THIS APPLICATION – APPLICATIONS ABSENT THESE
11.
ATTACHMENTS WILL BE RETURNED TO YOU:
1.
Brochure (which includes detailed time schedule, topics and speakers); speaker bios
2.
Application fee:
a.
KBA Members: $20
b.
Program Sponsors: $20 for programs two hours or less in length; $50 for longer programs
(SPONSORS ONLY: If the application is not submitted 30 days prior to the CLE activity,
the fee doubles to $40 or $100, respectively).
Minutes of instruction, not including breaks, meals or introductions:
12.
General: _______________
Ethics:
_______________
Total:
_______________
□
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13. Application submitted by:
Representative of Sponsor/Provider
Individual Attorney
a.
Name of Applicant (Print): ____________________________________________________________
Address if Individual Attorney applicant: ______________________________________________
_________________________________________________________________________________
Phone number: _______________________________ KBA ID number: ____________________
Signature: ____________________________________________
Date:
___________________
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