MINNESOTA COURT RULES

PROFESSIONAL RULES

Rules of the Minnesota State Boardof Continuing Legal Education

Forms provided here are for reference purposes. To download forms to fill out please visit the Minnesota Courts website.

Appendix II: AFFIDAVIT OF PRO BONO REPRESENTATION

MINNESOTA STATE BOARD OF CONTINUING LEGAL EDUCATION

180 East 5th Street, Suite 950

St. Paul, MN 55101

651-297-7100 www.mbcle.state.mn.us

An Affidavit of Pro Bono Representation must be submitted for each legal services provider for whom you provided pro bono service.

License Number:	_	Name: _
CLE Category:1		Firm Name: _
□	1	Street Address:2 _
□	2	Street Address: _
□	3	City, State, and Zip: _
□	Other _	Email:3 _
		Telephone: _

Name and address of referring legal services provider: _

_

Name and phone number of contact person at legal services provider: _

_

Type(s) of Representation Provided:
	□ Consumer	□ Economic Assistance		□ Education	□ Employment
	□ Family Law	□ Health	□ Housing	□ Immigration/Refugee	□ Individual Rights
	□ Juvenile	□ Seniors	□ Wills or Probate	□ Other: _
Date range of representation:4 _
# of hours of pro bono legal representation: ________ # of CLE credit hours claimed:5 ________

By signing this affidavit I swear (affirm) that:
■	I give permission to the Minnesota Board of Continuing Legal Education to contact the referring legal services provider to verify that the information I have provided is true and accurate; and
■	I understand that the Board may use this information that I have provided six (6) hours of pro bono legal representation for each one (1) hour of CLE credit claimed and that the pro bono legal representation provided qualifies in all respects under Rules 2R, 2S, 2T, and 6D.

Lawyer Signature: _		Date: _
_

¹ Your CLE reporting category is found on your lawyer license card issued by the Lawyer Registration Office and online at http://www.mncourts.gov/mars/.

² Address changes must be made by sending a written notice to the Lawyer Registration Office, 25 Rev. Dr. Martin Luther King Jr. Blvd., Room 305, St. Paul, Minnesota 55155.

³ An email confirmation will be sent after credits are approved or denied.

⁴ If representation covers more than one reporting period, submit a separate Affidavit of Pro Bono Representation for each reporting period. If representation is ongoing, write "ongoing" as the date representation ended.

⁵ You may claim 1 hour of CLE credit for every 6 hours of pro bono legal representation up to a maximum of 6 hours. Record credits in increments no smaller than .25 hours.

(Added effective July 1, 2008; amended effective February 1, 2010.)