Appendix IA: COURSE ACCREDITATION FORM (For Live Courses) MINNESOTA STATE BOARD OF CONTINUING LEGAL EDUCATION 180 E. 5th Street, Suite 950, St. Paul, Minnesota 55101651-297-7100 | www.mbcle.state.mn.us | email: oasis@mbcle.state.mn.us Please Note: volume of the Minnesota Statutes. Credit is awarded on the basis of one hour for each 60 minutes of actual classroom training. When a cour Fee: Rule 4A(8) requires that a $35 fee must accompany this application unless the course meets an exemption listed below. If you are applying for accreditation for an On-Demand course, please complete Appendix IB. Check one of the following: $35 fee is enclosed. No fee is required (check the basis for exemption): A previously approved course that has been recorded and is replayed at a later date in its entirety (See Rule 4A(8)()) Event Code of previously approved course A live course 60 minutes or less in duration (see Rule 4A(8)()) Sponsor Information Sponsor Name Sponsor Address (street, city, state, zip) Contact Email Address Contact Phone Number Submitter Information Check one: course sponsor course participant If submitter is co urse participant , please provide Attorney ID # Email Address: Course Information Course Title Date(s) of course City and State course held D escribe the expected audience or target audience to which the program is being marketed (if known): CLE Rule 5A(7) requires that course sponsors shall maintain a list of Minnesota participants for review, upon request. If you are the course sponsor, do you agree to maintain a list of Minnesota participants and make it available to the Board upon request? Yes No Check those which apply: live lecturein-house course (see Rule 5B)demonstration, role play, mock trialstudy tourvideotape/film (live moderator knowledgeable in topics addressed by course)live teleconferencelive satellite broadcast/webcast (live moderator knowledgeable in topics addressed by course) You must in clude the following information, but p lease d o not send volu minous materials and do not staple : (1)Start and stop times (a timed agenda) and a brief description of subject matter discussed for each course segment . Rule 4A(6 ) (2) Names and brief description of the credentials of the speakers and faculty members, including those persons designated to act as moderators for video or satellite programs. Rule 4A(4). (3) The type of CLE credit for which approval is sought for each segment of the course. Types of CLE Credit include: American LegalNet, Inc. www.FormsWorkFlow.com ETHICS OR PROFESSIONAL RESPONSIBILITY CONTENT : Check one of the following to describe the treatment of ethics or professional responsibility in the program: A portion of the program 30 minutes or more in length addresses ethics or professional responsibility and is marked as Ethics or professional responsibility concerns are addressed throughout the program but no distinct segment is 30 minutes or more in length. Rule 4B(1). No portion of the progra m addresses ethics or professional responsibility. Attached is an explanation of why ethics or professional responsibility content is not present in this program. Rule 4B(2). ELIMINATION OF BIAS EDUCATION CONTENT: Check one of the following to indicate whether Elimination of Bias credit is requested for this program: No credit for Elimination of Bias is sought. Elimination of Bias credit is sought and a narrative is attached. CLE Rule 6B order to be afforded such courses or segments of courses must be at least 60 minutes in length . The course must focus on issues in the legal profession and in the practice of law and not on issues of bias in society in ge neral. If elimination of bias credit is sought for som e portion of this course, please do the following: 1. requirements of Rule 6B; 2. Mark the segment or segments on the agenda that the sponsor believes fulfill these requirements; and 3. Please note that courses or segments of courses may address ethics and elimination of bias topics. A sponsor may seek credit in one category or the other, but a course or segment will not be accredited in both categories simultaneously. The Board will de LEARNING GOALS FOR MINNESOTA ELIMINATION OF BIAS COURSES 60 continuous minu tes in duration , must be directly related to the practice of law, must meet all other requirements of Rule 5 of the CLE rules and must be designed to meet one or more of the following goals: 1. To educate lawyers about the elimination of bias or prejudice in the legal profession, in the practice of law, and/or in the administration of justice; 2. To educate lawyers regarding barriers to hiring, retention, promotion, professional development and full participation of lawyers of color, women, and those and in the practice of law; or 3. To educat Reports, as well as in other studies, reports or treatises which describe bias and prejudice in the legal profession, in the practice of law, and/or in the administration of justice. Yes No If the application is seeking elimination of bias credit, I have attached a narrative explanation describing ho w the elimination of bias learning goals are met and how the program focuses on elimination of bi as in the legal profession and not merely elimination of bias in society in general. LAW AND LITERATURE Yes No This law and literature course is accompanied by documentation on Rule 4D. Yes No This law and literature course was designed to meet the standard CLE requirements set forth in Rule 5A. American LegalNet, Inc. www.FormsWorkFlow.com