FORM 6STATE BAR of GEORGIACOMMISSION on CONTINUING LAWYER COMPETENCY104 Marietta StreetSuite 100Atlanta, Georgia 30303(404) 527-8710REQUEST FOR CLE CREDIT BY THE TEACHER OF AN APPROVEDCONTINUING LEGAL EDUCATION ACTIVITYPLEASE NOTE: Regulation #5 under Rule 8-106 (B) applies specifically to in-house CLE activities.1.Name of Teacher: Telephone ()2.State Bar of Georgia Membership Number:3.Teacher's Full Address (Include Firm's Name): 4.Name of CLE sponsor: 5.Name of sponsor222s contact person:6. Sponsor222s full address (include Firm222s Name:7. Title of CLE activity:8. Date(s):9. Location(s):(city and state) (city and state) (city and state) (city and state)10. Is the Sponsor an Accredited Sponsor? YES NO 11. Has this CLE activity been approved? YES NO12. Did the teacher receive any compensation for teaching this CLE activity? YESNO(NOTE: MCLE Credit is not available for paid teaching)13. Please check one: Initial Presentation Repeat Presentation14. How long is the teacher222s presentation?minutes15. The requested number of (A) Total CLE Hours as well as the portions of the total hoursdevoted to (B) Ethics, (C) Trial and (D) Professionalism topics:(A) minutes = Total CLE Hours*(Please round the hours to the 60nearest one-tenth of an hour)(B) minutes = Total Ethics Hours* 60(C) minutes = Total Trial Hours* 60(D) minutes = Total Professionalism*(Minimum of60(1) per calendar year)*PLEASE SEE THE BACK OF THIS PAGE FOR THE REGULATIONS ON THE COMPUTATION OF CLE HOURS . PLEASE SUBMIT THIS FROM AT LEAST 30 (THIRTY) DAYS IN ADVANCE OF THE CLE ACTIVITY American LegalNet, Inc. www.FormsWorkFlow.com 16.Teacher222s fee of $5.00xthe total number of approved hours:paid by teacher in Januarypaid currently by sponsor 17.In the event that the CLE sponsor does not pay the teacher222s fee, the teacher understands that he will be responsible for the feedescribed in Rule 8-103 (c) and Regulations thereunder. This fee, of applicable, should accompany the reporting affidavitdescribed in Rule8-105 and the Regulations thereunder and should not be submitted with this request.18.The teacher represents that, to his knowledge, this CLE activity (a) does comply with the enclosed rules and regulations,including any amendments thereto and (b) has not been previously disapproved by the CCLE. The teacher acknowledges thatthe requested credit for instructing this CLE activity may be rejected in whole or in part by the CCLC.Date:Teacher222s Signature:CLE HOURS1.Only the time of actual instruction counts toward CLE credit hours. 2.Question and answer sessions are considered actual instruction and may be included for CLE credit provided suchquestion and answer sessions do not exceed ten (10) minutes per CLE credit hour. For example, a programapprovedfor six (6) total CLE credit hours may include up to one (1) total hour of a question and answer session.3.CLE credit is not given for:Breaks, Business meetings, Introductory remarks, Keynote speeches, Meals, or Speeches in connection with meals.4.No CLE credit is given for a CLE activity of less than 60 (sixty) minutes in length. A CLE activity means the entire program and not the individual topics. Therefore, a program may include individual topics of less than 60 (sixty)minutes in length.ETHICS HOURS1.Instruction in ethics includes topics on professional responsibility and malpractice.2.Instruction in ethics does not include topics such as attorney fees and client development except to the extent thatprofessional responsibility is directly discussed in connection with such topics. TRIAL HOURS1.Trial practice courses are defined as CLE exclusively limited to one or more of the following five (5) subjects: a.evidencec.criminal practice and proceduree.trial advocacyb.civil practice and procedured.ethical conduct of litigation2.Due to the "exclusively limited" requirement, trial CLE must be (a) clearly segregated and identified (b) aminimum of one (1) hour in length, and (c) limited to one or more of the five (5) listed subjects in order to receivetrial CLE credit. The "exclusively limited" requirement does not prohibit credit for a seminar that deals withone or more of the subjects stated in the Rule in the context of a particular field of trial practice, such as medicalmalpractice, personal injury defense, criminal cases, construction law, etc. PROFESSIONALISM HOURS American LegalNet, Inc. www.FormsWorkFlow.com