© ANZ National Certification Learn More Booklet

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Attachment 9 - Re-endorsed Certified Case Manager™ - Professional Training & Development Form - Page 2 of 2

Total time of all PTD activities: Please record the total sum of hours and/or minutes for all PTD activities. Please note you are required to have accumulated a minimum of 24 hours of PTD in the last 3 years to support your re- endorsement application. Comments: Optional: Please add any additional information or comments in relation to any numbered 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 must have accumulated a minimum of 24 hours of PTD activities as a pre-requisite to be eligible to apply for re- endorsement as a Certified Case Manager™ pursuant to my original endorsement (i.e. registration) with the CMSA.

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.