Kba Form 3 Kentucky Certificate Of Attendance
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1KBA Form 3
(June 2016)
KY Bar Association, CLE Commission, 514 West Main Street, Frankfort KY 40601-1883
PHONE (502) 564-3795 FAX (502) 564-3225 E-MAIL
KENTUCKY CERTIFICATE OF ATTENDANCE
for Approved/Accredited Continuing Legal Education Activity
Activity Identification
Sponsor: _____________________________________________________________________________________
Activity Title: __________________________________________________________________________________
Date: _____________ Location: ______________________ Activity # (REQUIRED): _____________________
Format of Activity:
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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.)
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Technological
(Technological programs are pre-recorded with no live interaction. A maximum of 6.0 credits may be
reported per educational year.)
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Approved In-House Activity
This program has been approved by the Kentucky Bar Association for a TOTAL of ________ CLE CREDITS.
Of this TOTAL, ______ credits are designated as ETHICS CREDITS.
If this program has not been previously approved by the Kentucky Bar Association, you must file a Form 1
“Application for Accreditation of CLE Activity”.
Attorney Certification
PLEASE NOTE: KY CALCULATES CLE CREDITS BASED ON A 60 MINUTE CREDIT HOUR.
By signing below, I certify that I attended the activity described above and am entitled to claim
a TOTAL of __________ CLE credits, including __________ ethics credits.
_________________________________________
________________________________________________
Name (Print)
Signature
______________________________________________________________________________________________
Address
Date: ____________________
KBA ID # (REQUIRED): ___________________
Credit for Faculty Preparation
□
□
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Speaker
Panel Member
Author of Materials
Please claim credit for your actual participation/teaching/attendance time above. Claim preparation time below only.
You may claim credit for preparation, not to exceed 12.0 CLE credits per education year (divide the actual hours of
preparation by 2 to determine CLE credit).
Hours of preparation: __________ ÷ 2 = __________ CLE credits. This total includes __________ ethics credits.
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