Competency Speaker Request

COMPETENCY SPEAKER REQUEST FORM

Please complete this form to request a speaker from the Lawyer Assistance Program to conduct a free MCLE presentation on the specialty Competency credit or a speaker for your law school.

1. Requester Information

Today's Date: * +

Requester's Name/Title: *

Requester's Full Address: *

Email Address: *

Phone Number: *

2. Organization/Event/Audience

Name of Organization: *

Type of Organization: *

Name of Event: *

Name/Title of Coordinator: *

Email Address: *

Phone Number: *

Who is the Audience?

Maximum estimated No. of Attendees: *

URL, if any, for Event:

3. Date/Event/Location

For 2024, we will continue to offer our presentations virtually only. Our 'Prevention and Detection' offering will feature the 'Impaired Colleague' presentation from 2023. Please note that if you have previously attended the 'Impaired Colleague' presentation or offered the presentation for your organization's attendees, those who have already attended the program will not be eligible for an additional hour of prevention and detection competency credit. Additionally, our new 'Wellness' presentation will fulfill the requirements for the wellness competency credit.

Date of Event (1st choice): * +

Time: *

Date of Event (2nd choice): +

Time:

Date of Event (3rd choice): +

Time:

What platform? *

If other, specify:

4. Topic/Format

We offer two types of competency presentations:

Prevention and detection competence—subfield credit
The presentation for prevention and detection competence must consist of education that relates to the prevention and detection of substance use disorders, mental illness, and other mental or physical issues that impair an attorney’s ability to perform legal services with competence.

Wellness competence—subfield credit
The presentation for wellness competence may include physical and mental wellness, well-being, or stress management so long as the activity addresses these topics in the context of the practice of law and the impact these issues can have on an attorney’s ability to perform legal services with competence.

Which competency presentation you would like? *

Format for Presentation:
(one speaker, panel, etc.) *

Length of Presentation:
(MCLE credit must be
a minimum of 1 hour) *

Are written materials required or desired? *

Yes

No

Are you an MCLE approved provider? *

Yes

No

If yes, what is your provider number:

If you are an MCLE provider, you may use this form to request a toolkit. The toolkit will include resources (PowerPoint and lesson plan) to assist you in hosting your own MCLE program for your firm, bar association, or organization. If you are not an MCLE provider, you can also receive these resources, but you will not be able to offer MCLE credit.

Would you like a toolkit of the competency presentation? *

Yes

No

Please indicate which toolkit you would like: *

Prevention and detection competence

Wellness competence

Additional Info:

How did you learn about our MCLE presentation?

Contact