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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.
COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)
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Attachment 2 - Professional Training and Development (PTD) Form A – Page 2 of 2
Description of PTD activity:
Please state relevancy of activity to
your practice area/role as it relates
to Case Management.
Supporting evidence of the PTD
activity:
Please state the evidence that you
can provide, if requested by the
CMSA, of this PTD activity
Total time of PTD activity:
In hours and/or minutes.
Comments (optional):
Please
add
any
additional
information or comments in relation
to this PTD activity that you
consider relevant for the attention
of the CMSA.
Declaration:
I solemnly and sincerely declare that the information I have
provided is true and correct to the best of my knowledge and belief.
I acknowledge that I may be required upon request by the CMSA
to provide supporting evidence of the PTD activity claimed within this
form.
I have read the Certification Application Guidelines and checked
that this PTD activity is a recognised and approved PTD activity by
the CMSA as recorded within the said Guidelines.
Signature:
_________________________________________
Date: