© 2013 Associate Fellow Application Guidelines

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Attachment 3 - Professional Training and Development (PTD) Form B - Page 2 of 2

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 72 hours of PTD activities as a pre-requisite to be eligible to apply for recognition as an Associate Fellow of the CMSA pursuant to the CMSA Associate Fellow Application Guidelines.

Declaration:

Signature:

_________________________________________

Date:

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

Associate Fellow Members (AFCMSA) of the Case Management Society of Australia & New Zealand (CMSA) adhere to the CMSA National Standards & National Code of Ethics for Case Management in all their day-to- day professional interactions with colleagues, the community, clients & /or representatives, key stakeholders & employer thus contributing to the veracity, integrity & fidelity of the profession of case management.