© ANZ National Certification Learn More Booklet

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Attachment 2 - Professional Training and Development (PTD) Form A – Page 2 of 2

Description of PTD activity: Please state relevancy of activity to your practice area/role as it relates to Case Management. Supporting evidence of the PTD activity: Please state the evidence that you can provide, if requested by the CMSA, of this PTD activity Total time of PTD activity: In hours and/or minutes. Comments (optional): Please add any additional information or comments in relation to this PTD activity that you consider relevant for the attention

of the CMSA. Declaration:

I solemnly and sincerely declare that the information I have provided is true and correct to the best of my knowledge and belief. I acknowledge that I may be required upon request by the CMSA to provide supporting evidence of the PTD activity claimed within this form. I have read the Certification Application Guidelines and checked that this PTD activity is a recognised and approved PTD activity by the CMSA as recorded within the said Guidelines.

Signature:

_________________________________________

Date:

COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)

C A S E M A N A G E M E N T S O C I E T Y O F A U S T R A L I A & N E W Z E A L A N D 1 9 9 6

C E R T I F I E D C A S E M A N A G E R A U S T R A L I A & N E W Z E A L A N D

The Case Management Society of Australia and New Zealand and Affiliates (CMSA) Certification sets the benchmark of excellence in case management. Certified Practising Case Managers™ (CPCM) and Certified Case Managers (Non Practising)™ (CCMNP) adhere to the CMSA National Standards and National Code of Ethics for Case Management and are recognised for their advanced education, experience, knowledge and skills by their colleagues, consumers and employers.