NYLA SSL 2023 Conference - CTLE Transcript Request Form

To receive CTLE credit, attendees are required to:

1.) Submit one (1) program evaluation for each program they wish to receive credit for within the 2023 event. Please note you can evaluate up to 10 programs in one form. Multiple forms can be completed if necessary.

2.) Submit a CE Transcript Request Form to receive CTLE credit generated in your NYLA Account and a certificate to be emailed to email provided in the request form. Each attendee wishing to receive credit should complete this form one (1) time.

All fields in an evaluation are reguired. Please do not submit an incomplete form. All incomplete submissions will be deleted.

Attendees will have 30 business days (Tuesday, June 6th) following the event to submit all of their program evaluation forms and the CTLE Transcript Request Form. Any requests submitted after the 30-day deadline will incur a $10.00 administrative fee.

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* 1. Attendee Name

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* 2. Attendee Email

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* 3. Last FOUR Digits of Attendee's Social Security Number:

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* 4. Attendee Date of Birth

Date / Time

Date

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* 5. Attendee Address

Address:

City:

State:

Zip Code:

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* 6. Did you complete all required Program Evaluations for each session attended at the event?

Yes

No. I forgot to complete an evaluation for my program(s)