**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.
Are you licensed as a Psychologist from the Maryland Board of Examiners of Psychologists? (If you respond Yes, please upload a copy with your application)
Yes
No
2.
If yes, please provide your license type, license number and expiration date below.
3.
Describe your experience in child/adolescent psychology.
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.