REPORTING YEAR ENDING JUNE 30, 200___ DUPLICATE AS NEEDED INITIAL FILING____SUPPLEMENTARY FILING____ APPENDIX G - Summary Reporting Form MAIL TO: Rhode Island Mandatory Continuing Legal Education Commission John E. Fogarty Judicial Annex 24 Weybosset Street, 3rd floor Providence, RI 02903 (401) 222-4942 FULL NAME:_____________________________________________PHONE#_________________RI ATTORNEY ID#_____________ ADDRESS:______________________________________________________________________________________________________ FULL-TIME MILITARY ATTORNEY: ___yes ___no SWORN IN DURING THE PREVIOUS REPORTING YEAR___yes___no This form will not be accepted unless completed in full, legible, and certificates of attendance from approved sponsors are attached. The form should be submitted as soon as all ten credits are accrued (inclusive of two ethics credits). *NOTE: On-line max includes on-line, telephonic, video and sound tape courses. What portion of total assigned to: Sponsoring Agency Program Total Teaching Ethics In-House AuthorOn-line* Date Credit Credit Credit Credit ship Cr. Credit (not course name) (max. 6) (min. 2) (max. 5) (max. 5) (max. 3) Carry forward from year ending 200__ Copy of MCLE transcript must be attached ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ _________________________________ ________ ________ ________ ________ ________ ________ _______ I certify that the information hereon, to the best of my knowledge, is complete and accurate, and that I did in fact attend, for the number of credits indicated, the courses listed. SIGNATURE:_____________________________ American LegalNet, Inc. www.USCourtForms.com