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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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CERTIFIED CASE MANAGER™
- 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
Certified Case Manager™
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 Certified Case Manager
™
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.
Attachment 3 - Professional Training and Development (PTD) Form B – Page 1 of 2