© UAE Certification Guidelines 2017

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PATHWAY 4 – CERTIFIED CASE MANAGER (NON PRACTISING)™ APPLICATION

Title First Name Last Name Gender

Business Address - Street Name/PO Box

Business Address Line 2

Business Address Line 3

Area

Emirate State / Province

Postal code

Country

Business Phone

Mobile

Primary Email Address

Secondary Email Address

Date of Birth

Employer Name (Agency)

Position Title

Department Name I have read the Certification Application Guidelines.

1. Yes 2. No - please ensure you have read these guidelines prior to continuing with your application 1. Yes 2. No - you have failed to meet the pre-requisite requirement for this application 1. Delivery of Case Management 2. Supervision of Case Managers 3. Management of Case Management Programs and/or Portfolios

I have a minimum of 2 years FTE (3618 hrs) vocational case management experience. Please note you must have practised for 12 months (1824 hrs) in the last 3 years? Please select area of case management practice (i.e. practical or theoretical)

4. Case Management Education 5. Case Management Research

Please attach the Employment Verification Form (copy must be signed by your employer & Certified) OR if Self Employed please attach a Statutory Declaration. Please attach a copy of your Curriculum Vitae (CV) Please attach your Professional Training and Development Forms A and Form B (copies must be signed and Certified)

1. Employment Verification Form 2. Self Employed (Statutory Declaration)

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

C E R T I F I E D C A S E M A N A G E R S U N I T E D A R A B E M I R A T E S

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 & A F F I L I A T E S 1 9 9 6

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. 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.