CLE CREDIT REQUEST, ATTENDANCE, & AFFIRMATION FORM
For Holland & Knight Live Webinars and On-Demand Programming
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
firstname.lastname@example.org. 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.
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:
Non-Holland & Knight Attorneys, please return form to The Holland & Knight Institute, 524 Grand Regency Blvd.,
33510 or via e-mail at email@example.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 firstname.lastname@example.org.
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)