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FORM WITHIN 30 DAYS OF ATTENDING THE LIVE

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CLE CREDIT REQUEST, ATTENDANCE, & AFFIRMATION FORM
For Holland & Knight Live Webinars and On-Demand Programming
Instructions:
To track online attendance as required by MCLE jurisdictions, please complete this form and return it to
the Holland & Knight Institute at Tampa-Firmwide via interoffice mail or e-mail it to
hkinstitute@hklaw.com. For non-Holland & Knight attorneys requesting credit, please complete the
form and follow directions in the box below.
New York Attorneys: Do not use this form. Please complete and send the NY-specific affirmation
form to the Holland & Knight Institute. That form is available with the materials for this program. If you
are licensed in NY and another state(s), you will need to complete both forms.
Program Title:
Original Program Date:
I am requesting credit for the following jurisdiction(s):
(Check all that apply and enter state bar number.)
FL Bar #
CA Bar #
VA Bar #
IL Bar #
TX Bar #
GA Bar #
Other State and Bar #
I certify completion of the program listed above on:
Attorney's Full Name:
For non-Holland & Knight attorneys requesting credit, also fill in below:
Company Name:
E-mail address:
Phone:
Non-Holland & Knight Attorneys, please return form to The Holland & Knight Institute, 524 Grand Regency Blvd.,
Brandon, FL
33510 or via e-mail at hkinstitute@hklaw.com.
Please read the important information below regarding application for CLE credits
• The Holland & Knight Institute will seek credit for programs it hosts online, from all jurisdictions as appropriate.
• Some states may not award CLE credits for a program due to content, jurisdictional restrictions, or that state's rules.
• Due to delays in reviewing CLE credit applications, approval by certain states may take as long as 10 weeks.
• We will contact you via e-mail once we receive approval or denial of the application from the requested state bar(s).
*
Submitting this form does not guarantee that you will receive CLE credit. You will receive credit
only if the course is approved by jurisdictions to which we have applied. Due to application rules in
effect in the following jurisdictions, CLE credit will not be available in: Alabama, Hawaii, Indiana,
Kentucky, Louisiana, Minnesota, Mississippi, Nevada, North Carolina, North Dakota, Ohio, Oklahoma,
South Carolina, Tennessee, Utah, Vermont, and West Virginia.
If you have any questions, please contact the Holland & Knight Institute at hkinstitute@hklaw.com.
OR Bar #
FAILURE TO COMPLETE AND RETURN THIS FORM IN A TIMELY MANNER MAY RESULT IN
MCLE CREDIT NOT BEING AWARDED FOR VIEWING THE PROGRAM. PLEASE RETURN THIS
FORM WITHIN 30 DAYS OF ATTENDING THE LIVE PROGRAM.
Please Note: If seeking credit for viewing a recording, form must be returned by the earlier of
within 180 days of the live program date or by Dec. 31 of the year the live program was held.
Financial Services Industry Crystal Ball (2)
04/06/21
ATTORNEY AFFIRMATION
NEW YORK CLE CREDIT FOR NONTRADITIONAL FORMAT COURSE
I, ___________________________________, acknowledge receipt of the course materials for:
(attorney name)
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
G Teleconference
G Webconference
G Videoconference
G Audiotape
G Videotape
G CD
(check one)
G CD-ROM
G DVD
G Audio File
G Online
G Live Broadcast
G Other __________________
(Please Describe)
COURSE CODE: _______________
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: ___________ Code #3: __________
Code #4: ___________ Code #5: __________
______________________________________________
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.
• New York attorneys should retain a copy of this affirmation along with their New York CLE
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 (.5-hour) increments.
January 2007 - Sample
•
Please submit this form within 30 days of
watching a live webinar or, if a recording, within one
year of the live date.
___________________________________________________________________________
(course title)
Financial Services Industry Crystal Ball (2)
FOR NON-H&K ATTORNEYS REQUESTING CREDIT, ALSO FILL IN BELOW:
Company Name:        Bar #(s):      
E-mail:       Phone:      
Non-H&K Attorneys: Please return form to The Holland & Knight Institute, 524 Grand Regency Boulevard, Brandon, FL
33510 or via e-mail at HKInstitute@hklaw.com.
Holland & Knight LLP
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Presentation Evaluation
Financial Services Industry Crystal Ball
(2)
Tuesday, April 6, 2021
1. Overall, the Program was:
Excellent Good Fair Poor
2. How would you rate the written materials you received?
Excellent Good Fair Poor
3. How would you rate the speaker’s knowledge of the subject matter and teaching effectiveness?
Excellent Good
Fair
Poor
4. What did you like the most about the program?
5.
What did you like the least about the program?
6.
What topics would you like to see offered in the future?
7.
Please provide additional comments, including any about how the program was delivered
and/or the learning environment:
Name (optional):
E-mail (optional):
Please return this form to the Holland & Knight Institute
524 Grand Regency Blvd, Brandon, FL 33511
Contact the Holland & Knight Institute at hkinstitute@hklaw.com
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FORM WITHIN 30 DAYS OF ATTENDING THE LIVE

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Completed 6 April 2021

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