© 2013 Associate Fellow Application Guidelines

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Please attach a scanned copy of all PTD Form A as a record of your PTD activities (each copy must be signed and Certified). Note you must scan a copy of Form A into one (1) PDF document only. Multiple uploads are not available. Please attach a scanned copy of PTD Form B as a summary of all 72 hrs of PTD activities (copy must be signed and Certified). Please attach your Certificate of Attainment CMCT01 Case M a n a g e m e n t ( N a t i o n a l C e r t i f i c a t i o n ) C o m p e t e n c y T r a i n i n g Please attach Referee Form 1 (copy must be signed and Certified). Please attach Referee Form 2 (copy must be signed and Certified). I have submitted the following evidence as a mandatory requirement of my application and acknowledge that failure to do so will render my application incomplete for the purpose of assessment by the CMSA. I solemnly and sincerely commit to read, understand, utilise and apply the CMSA National Code of Ethics within all my professional interactions as a member of the CMSA. I solemnly and sincerely commit to read, understand, utilise and apply the CMSA National Standards within all my professional interactions as a member of the CMSA. I have read and consent to the CMSA Privacy Policy (see www.cmsa.org.au) and understand how it relates to the use of my personal information. I have read, acknowledge and agree to abide by the CMSA Constitution and By-laws. I declare the above to be true and correct.

1. Qualifications (listed only) 2. Employment Verification Form OR Statutory Declaration 3. Curriculum Vitae (CV) 4. Professional Training and Development (PTD) Forms (Form A & Form B) 5. Certificate of Attainment CMCT01 Case Management ( N a t i o n a l C e r t i f i c a t i o n ) C o m p e t e n c y T r a i n i n g

6. Referee 1 7. Referee 2

I hereby agree

I hereby agree

1. Yes 2. No

I hereby agree

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.