**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 Master's degree in the field of Public Health from an accredited college or university with a minimum of three graduate courses in Epidemiology and one graduate course in Biostatistics?
Yes
No
2.
If yes, please list the required coursework (three graduate Epidemiology courses and one graduate course in Biostatistics) in the space below using the following format. If no, please indicate N/A. You may also attach a copy of your official or unofficial transcripts to your application:
Example: Course Number Title Credits Earned
EPI 101 Introduction to Epidemiology 3.0
*This information will be verified upon employment.
3.
Describe your experience working with hospital infection preventionists.
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.
Describe your knowledge of and/or experience reviewing and abstracting data from medical records and/or laboratory reports.
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.
5.
Describe your knowledge of and/or experience with infectious disease surveillance programs.
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.
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