Ncsb Form 7 - Teacher'S Application For Cle Credit

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NCSB Form 7 rev. 1/2016
THE NORTH CAROLINA STATE BAR
BOARD OF CONTINUING LEGAL EDUCATION
217 East Edenton Street, Post Office Box 26148
Raleigh, NC 27611
(919) 733-0123
TEACHER’S APPLICATION FOR CLE CREDIT
NOTE: Activity must be approved for CLE credit before teaching credit can be awarded. If activity has not
been previously approved, also prepare a Bar Member’s Application for CLE Credit (Form 3).
1. Name of Teacher:_______________________________________ Telephone: (______)____________________________
2. NC State Bar Membership Number:___________________ ______ E-mail: ______________________________________
3. Address:___________________________________________________________________________________________
4. Name of Sponsor of CLE Activity: _______________________________________________________________________
5. Name of Sponsor Contact:________________________________ Telephone: (
) ______________________________
6. Address of Sponsor: _________________________________________________________________________________
7. Exact Title of CLE activity:_____________________________________________________________________________
8.
How long was the teacher’s presentation: ________________ minutes
9.
Requested Number of CLE Hours for Teaching or Serving on a Panel (Complete part A, B, or both):
A.
Initial Presentation: Exact Date: _________ Location (city, state/country):_________________________
Has this CLE activity been approved for credit?  Yes  No – Submit Application for CLE Credit.
 10 = _________ Hours
_____ Minutes/Ethics/Professional Responsibility/Professionalism
 10 = _________ Hours
_____ Minutes/Substance Abuse/Mental Health Awareness
 10 = _________ Hours
_____ Minutes/General (any substantive law topics that do not qualify above)
 10 = _________ Hours
_____ Minutes/Total (please round downward to the nearest ¼ of an hour)
B.
Repeat Presentation: Exact Date: _________ Location (city, state/country):_______________________
Has this CLE activity been approved for credit?  Yes  No – submit Application for CLE Credit.
 20 = _________ Hours
_____ Minutes/Ethics/Professional Responsibility/Professionalism
 20 = _________ Hours
_____ Minutes/Substance Abuse/Mental Health Awareness
 20 = _________ Hours
_____ Minutes/General (any substantive law topics that do not qualify above)
 20 = _________ Hours
_____ Minutes/Total (please round downward to the nearest ¼ of an hour)
10.
Requested Number of CLE Hours for Attending Other Portions of the Program:
 60 = _________ Hours
_____ Minutes/Ethics/Professional Responsibility/Professionalism
 60 = _________ Hours
_____ Minutes/Substance Abuse/Mental Health Awareness
 60 = _________ Hours
_____ Minutes/General (any substantive law topics that do not qualify above)
 60 = _________ Hours
_____ Minutes/Total (please round downward to the nearest ¼ of an hour)
11.
Total Hours requested for teaching and attendance (9A + 9B +10):
Ethics/Professional Responsibility/Substance Abuse Hours
= ________ Hours
Substance Abuse/Mental Health Awareness Hours
= ________ Hours
Total General Hours
= ________ Hours
Total CLE Hours
= ________ Hours
12.
In the event that the sponsor of the CLE activity does not pay the NC State Board of CLE fee of $3.50 per total number of
CLE hours (teaching and non-teaching) for which credit is sought, the Teacher agrees to pay these fees when billed. See
reverse for fee information.
13.
The teacher represents that to his or her knowledge this CLE activity (A) complied with the Continuing Legal Education
Rules and Regulations including any amendments thereto, and (B) has not been previously disapproved by the Board of
Continuing Legal Education.
Date:___________________ Teacher’s Signature:_________________________________________________
CONTINUED ON BACK

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