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ATTORNEY AFFIRMATION NEW YORK CLE CREDIT FOR NONTRADITIONAL FORMAT COURSE I acknowledge receipt of the course materials for attorney name course title I certify that I have listened to and/or viewed the above course in its entirety. Therefore I request that I be awarded the applicable number of New York CLE credits for this course. Format check one G Teleconference G Videoconference G Audiotape G Videotape G CD COURSE CODE G CD-ROM G DVD G Audio File G Online G Live Broadcast G Other Please Describe During the course or program you will see and/or hear a CLE code. Please enter the code in the above field. If you do not include the code you will not be awarded New York CLE credit. If there are multiple codes for example a separate code for each segment of a program please enter here Code 2 Name of CLE Provider Signature of Attorney Date of completion of CLE course New York attorneys earn CLE credit as of the date they complete a CLE course To obtain New York CLE credit please complete and sign this form and then submit it to the CLE provider. Once your participation is verified by the provider a New York CLE Certificate of Attendance will be issued to you by the provider. Certificate of Attendance. Experienced New York attorneys attorneys who have been admitted to the New York Bar for more than two years may earn CLE credit through nontraditional formats. Generally newly admitted attorneys may not earn CLE credit through nontraditional formats. Please note that in New York one hour of CLE credit consists of at least 50 minutes of instruction* Credit hours must be calculated in no less than 25-minute. Therefore I request that I be awarded the applicable number of New York CLE credits for this course. Format check one G Teleconference G Videoconference G Audiotape G Videotape G CD COURSE CODE G CD-ROM G DVD G Audio File G Online G Live Broadcast G Other Please Describe During the course or program you will see and/or hear a CLE code. Format check one G Teleconference G Videoconference G Audiotape G Videotape G CD COURSE CODE G CD-ROM G DVD G Audio File G Online G Live Broadcast G Other Please Describe During the course or program you will see and/or hear a CLE code. Please enter the code in the above field. If you do not include the code you will not be awarded New York CLE credit. Please enter the code in the above field. If you do not include the code you will not be awarded New York CLE credit. If there are multiple codes for example a separate code for each segment of a program please enter here Code 2 Name of CLE Provider Signature of Attorney Date of completion of CLE course New York attorneys earn CLE credit as of the date they complete a CLE course To obtain New York CLE credit please complete and sign this form and then submit it to the CLE provider. If there are multiple codes for example a separate code for each segment of a program please enter here Code 2 Name of CLE Provider Signature of Attorney Date of completion of CLE course New York attorneys earn CLE credit as of the date they complete a CLE course To obtain New York CLE credit please complete and sign this form and then submit it to the CLE provider. Once your participation is verified by the provider a New York CLE Certificate of Attendance will be issued to you by the provider.

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