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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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1
9
9
6
How long have you known the
applicant?
Please record approximate time in
years and actual time in months if
this period is less than 2 years.
Please provide a comprehensive
description,
including
your
comments and observations, in
relation to the vocational
experience and performance of
the applicant as it relates to their
case management role (i.e.
practical,
managerial
or
theoretical)
(150
–
200 words)
Do you know of any information
that may give rise to concern of
the applicant that may disqualify
the applicant as being a fit and
proper person for recognition by
the CMSA as an Associate
Fellow?
Yes
Please provide details:
No
Comments (optional):
Please
add
any
additional
information or comments 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 solemnly and sincerely declare that I have not omitted any
information that may give rise to concerns by the Case Management
Society of Australia and New Zealand (CMSA) as to the
appropriateness of the applicant receiving recognition as an
Associate Fellow nor unduly challenge the veracity, integrity or
fidelity of the Society, its members and the profession of Case
Management.
Signature:
_________________________________________
Date:
Attachment 4 - Referre Form 1 - Page 2 of 2