Form 12 (SCR 213) NEVADA BOARD OF CONTINUING LEGAL EDUCATION 457 COURT STREET, SECOND FLOOR RENO, NEVADA 89501 TEL (775) 329-4443 FAX (775) 329-4291 E-MAIL nevadacleboard@sbcglobal.net APPLICATION FOR REINSTATEMENT Name of Attorney:_____________________________________________Bar#_____________________ Mailing Address: ______________________________________________________________________ City, State, Zip Code___________________________________________Telephone________________ INSTRUCTIONS TO APPLICANT: In order for the Board of Continuing Legal Education to reinstate the applicant to active status, a minimum of 15 hours (six of which must be in ethics) of accredited educational activity must be completed within a period of 12 months immediately preceding the date of this Application for Reinstatement. A fee of $500 (check made payable to the Nevada Board of Continuing Legal Education) as required under SCR 213, and the $40 annual fee, as required under SCR 208(11), are to be paid for the year in which reinstatement is sought. Credit hrs. ATTENDANCE: Please list program sponsor, title, location and date of program. obtained Attach Certificates of Attendance to this application. ______________________________________________________________________ ________ ______________________________________________________________________ ________ ______________________________________________________________________ ________ ______________________________________________________________________ ________ ______________________________________________________________________ ________ ______________________________________________________________________ ________ OTHER: To be used for instruction and authorship. Describe activity in detail. Credit hrs. obtained ______________________________________________________________________ ________ ______________________________________________________________________ ________ ******************************************************** I,________________________________, under penalty of perjury state that I am a member of the PRINT NAME State Bar of Nevada. I have read the foregoing application and believe it to be true to the best of my personal knowledge. __________________________________________ SIGNATURE ******************************************************** APPROVED:__________ DISAPPROVED:____________ CONDITIONS:_____________________ _______________________ __________________________________________ Revised 03/30/10