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17

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