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#24-003330-0001
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1.

Do you possess a Bachelor's degree from an accredited college or university in Community Nutrition, Dietetics, Foods and Human Nutrition, Food Systems Management or Nutrition Education? 

Please upload a copy of your transcript(s) to the application.  Unofficial versions of transcript(s) are acceptable.

Yes No
2.

If you responded YES to the above question, what field is your Bachelor's degree in?

3.

Describe your breastfeeding management experience.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box. 

4.

Are you certified in Breastfeeding?

Yes No
5.

Describe your experience with communications and customer service skills.

This experience must also be included on your application (please 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.


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