Certification Of Attendance Form 2

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Virginia MCLE Board
Virginia State Bar
1111 East Main Street, Suite 700
Richmond, VA 23219-3565
(804) 775-0577 · Web site:
CERTIFICATION OF ATTENDANCE (FORM 2)
Pursuant to Paragraph 17B, C and D of Section IV, Part Six, Rules of the Supreme Court of Virginia. The information provided will be available for
inspection by the public under the Freedom of Information Act. Complete all requested information and sign certification.
Contact the Sponsor First for Virginia Approval Information and Form. The Virginia certification of attendance and
Virginia course approval ID# has been provided to the sponsor for all Virginia approved programs except ABA programs.
Certify Your Attendance Online at
Member Name:
VSB Member Number: _________________________
Official Address
of Record:
________________________________________________
Daytime Phone ( ______ ) _____________________
_______________________________________________
E-Mail Address: _______________________________
City
State
Zip
Course ID Number: ___________________________________________________________________________________________
Sponsor:____________________________________________________________________________________________________
Course/Program Title:__________________________________________________________________________________________
CLE (Ethics) Credits: ________________________ ( ______ ) Ethics
CERTIFICATION
Date(s) Attended:
Location(s):
Delivery method:_____Live or Group Video
_____*Live Telephone or live Webcast
_____ *Videoconference or Satellite
_____* Internet on-demand _____*CD-rom _____♦ Video/DVD _____♦Audio/CD
_____Other___________________________________________________________________________________
Setting:
_____Group (with other attendees) _____* Individual attendance at my location
*Distance Learning Programs Require Attendance Form Verified and Provided by the Course Sponsor when done in an Individual Setting.
♦Video and Audio programs require at least 2 attorneys in attendance
By my signature below I certify:
___ I attended a total of
(hrs/mins) of approved CLE, of which (
) (hrs/mins) were in approved Ethics.
___ The sessions I am claiming had written instructional materials to cover the subject.
___ I participated in this program in a setting physically suitable to the course.
___ I was given the opportunity to participate in discussions with other attendees and/or the presenter (in real time or via e-mail).
___ I understand I may not receive credit for any course/segment which is not materially different in substance than a course/segment
for which credit has been previously given during the same completion period or the completion period immediately prior.
___ I understand that a materially false statement shall be subject to appropriate disciplinary action.
NOTE: Credit is awarded for actual time in attendance rounded to the nearest half hour.
Date
Signature
MCLE Completion Deadline - October 31
Deadline to Certify MCLE Approved Hours - December 15
Subsequent Late Reporting Deadline – February 1
A $100 fee will be charged for failure to comply with each deadline

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