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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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FELLOW - REFEREE ONE (1) FORM
TO THE REFEREE
Your role as a
“
referee
”
is important in the substantiation
of information provided by the
“
applic
ant”
to the CMSA.
Applicants seeking recognition as a Fellow of the Case
Management Society of Australia and New Zealand (CMSA)
must provide full details of their referees. It is
recommended by the CMSA that as a nominated referee
you take the time to review and discuss the application
and supporting documentation prior to it being submitted
online to the CMSA. It is important to know that as a
referee, you may be contacted by a representative of the
CMSA to either clarify or verify any details or claims made
by the applicant or yourself in support of the aforesaid
application.
Please complete, print and sign this form prior to
returning it to the applicant. Information must be typed
into this form. Handwritten versions of the referee form
will not be accepted by the CMSA.
Applicant Name:
I am providing a professional reference for (insert full name):
Referee 1 details
Title
(Dr, Prof, Mr, Mrs, Ms):
SURNAME:
GIVEN/FIRST name:
Position title:
Organisation or Company name:
Postal address:
Suburb:
State/Territory (Australia):
Town/City (New Zealand):
Postcode:
Country:
Phone:
Mobile:
Email:
In what professional capacity do
you know the applicant?
(e.g. academic, advisor, case
manager, colleague, consultant,
clinician, educator, executive,
manager, mentor, peer, policy
planner, practitioner, supervisor,
researcher etc)
Attachment 4 - Referre Form 1 - Page 1 of 2