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Associate Fellow Members (AFCMSA) 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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ASSOCIATE 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 an Associate 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