KENTUCKY COURT REPORTERS ASSOCIATION
VOLUNTARY CERTIFICATION PROGRAM
APPLICATION FOR PRO BONO
CONTINUING EDUCATION CREDITS

Reporter’s Name_________________________________________________

                                                     

Telephone # ____________________________________________________

 

E-mail address (mandatory) _________________________________________

 

Name of organization for which pro bono service was provided

______________________________________________________________

 

Description of pro bono service provided ______________________________

______________________________________________________________

 

Date pro bono service was provided__________________________________

 

Number of hours of pro bono service provided _________________________   

(NOTE:  Kentucky Justice Association Trial by Jury at the State Fair:

 .1 CEU will be given for each trial reported, regardless of length of trial.)

 

Name of supervisor of pro bono event (please print)

_____________________________________________________________

 

Telephone # of supervisor ________________________________________

 

Signature of supervisor __________________________________________

 

Signature of reporter ____________________________________________

 

 

PLEASE MAIL ORIGINAL SIGNED FORM TO:

 

MELISSA ENGLEMAN, RPR,CCR(KY)

2260 CORYDON NEW MIDDLETOWN ROAD

CORYDON, IN 47112

 

REMINDER:  You are limited to 1.0 CEUs earned through pro bono work per 3-year cycle.                                                                                                             (Revised 6/13)