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Fellow Members (FCMSA) 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.
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Attachment 2 - Professional Training and Development (PTD) Form A - Page 1 of 2
FELLOW- PROFESSIONAL TRAINING & DEVELOPMENT FORM PART A
TO THE APPLICANT
The information being sought in this form is for the
purpose of verifying your 72 hours of Professional Training
and Development (PTD) undertaken in the last 3 years and
backdated from the date of your online application to the
CMSA. Activities undertaken must be related to Case
Management and specific to your practice area/role as it
relates to case management (practical or theoretical). Full
details of approved PTD activities are listed within the Fellow
Application Guidelines.
As part of the CMSA
’s ongoing Quality Assurance
it is
important that you understand that the Society will
conduct random audits of Fellow applications and
accordingly you may be contacted by a representative of
the CMSA seeking evidence of the information you have
claimed within this form. If you are audited you will be
given 28 days from the date of notice by the CMSA to
submit evidence of your PTD activities.
A separate form must be completed for each PTD activity
until you have accrued the minimum total of 72 hours of
PTD. All copies of Form A must be certified prior to being
submitted online (along with a summary of all of your PTD
activities within Form B) to the CMSA. Applications
submitted without either Form A or Form B will be
considered incomplete and will not be accepted by the
CMSA.
Please complete, print and sign this form. All content
must be typed into this form. Handwritten versions of the
form will not be accepted by the CMSA.
Applicant details:
Title
(Dr, Prof, Mr, Mrs, Ms):
SURNAME:
GIVEN/FIRST name:
PTD Number:
Please insert a number for each
time you complete this form. For
example if this is the first PTD
activity you are claiming please
insert
“
1
”
, The next time you
complete Form A you should insert
“
2
”
, then
“
3
”
etc in numerical order
for each Form A you complete.
Title of PTD activity:
Date of PTD activity:
Details of PTD activity:
Presenter:
Company:
Description of PTD activity:
Please state relevancy of activity to
your practice area/role as it relates
to Case Management.