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#24-002729-0004
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***


1.

Do you have two years experience or more of supervising employees or exercising responsibility for program development?  If you answer YES, please explain your experience in detail. Include name of employer, job title, dates of employment and hours worked per week. If you do not possess this type of experience, please indicate N/A.

 

2.

Describe your experience in the administration of a human services program or experience conducting studies and analyses of programs, procedures, practices and organizations? Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not have this type of experience, please indicate N/A.

3.

Describe your experience working with government grants and/or programs.  Include employer, duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

4.

Do you have an understanding and experience working with Older Americans Act (OAA) programs?  If yes, describe your experience.  Include employer, duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

5.

Describe your experience working with frail older adult/disabled populations.  Include employer, duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

6.

Describe your experience managing large grants.  Include employer, duties, dates of employment and number of hours worked per week.  Also, indicate amount of the grants you managed.  If no experience, indicate N/A.


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