Nevada Board of Continuing Legal Education

FORM 4

(Board Reg. 10)

NEVADA BOARD OF CONTINUING LEGAL EDUCATION

457 COURT STREET, SECOND FLOOR

RENO, NEVADA 89501

TEL (775) 329-4443/FAX (775) 329-4291

E-MAIL WEBSITE nvcleboard.org

APPLICATION FOR APPROVAL

OF AUTHORSHIP

1. Name, address and telephone number of applicant: ______

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2. Title of the authored ("work-product"): ______

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3. Name of the publication in which it appeared, or course at which it was presented: ______

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4. Publication date (MMDDYY):* ______

5. Name, address and telephone number of publisher: ______

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6. If applicable, does the publication have distribution to at least 200 attorneys? ______

7. Is the work-product an original work? _____Yes _____No

If no, original year produced ______and redlined version (please attach).

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8. Is the applicant the principal author of the work-product? _____Yes _____No

If no, clearly describe which parts are attributable to the applicant (citing pages, sections or chapter headings): ______

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Give name, address and telephone number of each co-author, and indicate the extent of that person's contribution to the work-product: ______

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9. Estimate the number of hours expended by applicant in preparing the work-product: ______

10. State the number of credits sought by applicant: ______general credits______ethics

credits______substance abuse credits.

11. State the calendar year for which credit is being sought:** ______

12. Attach a copy of the work-product or a representative portion of the work- product.

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DATE SIGNATURE BAR NUMBER

*UNDER BOARD REGUATION 10 ADOPTED BY THE BOARD OF CONTINUING LEGAL EDUCATION, AN APPLICATION FOR AUTHORSHIP CREDITS MUST BE MADE WITHIN 60 DAYS OF THE PUBLICATION OF AUTHORED WORK.

**Credits may be allocated, at the election of the author, in the year in which the work is delivered to the publisher and accepted for publication, or in the year in which publication actually occurs. No person may obtain more than twelve (12) hours of credit for any calendar year for authorship.

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APPROVED/DISAPPROVED Date: ______Credits: ______

Conditions: ______

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Signature

Revised 07/01/15