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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 3 - Professional Training and Development (PTD) Form B - Page 1 of 2
FELLOW - PROFESSIONAL TRAINING & DEVELOPMENT FORM PART B
TO THE APPLICANT
The information being sought in this form is a summary of
all of the Professional Training and Development (PTD)
activities you have claimed in each Form A. Its purpose is
to verify you have accumulated the minimum 72 hours of
pre-requisite PTD for your Fellow application, by cross
referencing the details in Form B to the details you have
recorded individually in Form A. It is the responsibility of
the applicant to record, calculate and check the total hours
of the PTD activities claimed on this form. It is
recommended that you seek assistance from another
individual to check the accuracy of your final calculations.
It is important that you understand that the Society will
conduct random audits of 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 copy of Form B must be certified prior to being
submitted online. You must submit Form A for each
individual PTD activity and Form B as a summary of all
your PTD activities 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, title and time
(hours/minutes) of each
individual PTD activity you have
claimed on Form A.
Please number and list all of the
PTD activities you have entered
individually onto Form A, including
the individual hours and/or minutes
for each PTD activity.
Total time of all PTD activities as
claimed on Form A:
Please record the total sum of
hours and/or minutes for all PTD
activities you have recorded and
claimed on each Form A. Please
note you are required to have
accumulated a minimum of 72
hours of PTD in the last 3 years to
support your application.