**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.
When did you earn your master's degree (please indicate the month and year)?
4.
Describe your experience as an epidemiologist.
Include name of employer, job title, dates of employment, and hours worked per week for each relevant position. If you do not have this experience, put N/A in the box below.
5.
Describe your experience with injury surveillance and data.
With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position. This experience must also be reflected in the "Work Experience" section of your application. If you do not have this experience, put N/A in the box below.
6.
Describe your Statistical Analysis Systems (SAS) experience. In your description, please include the job duties performed, name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.
7.
Please describe your supervisory experience. Include employer name(s), job title(s), dates of employment, and titles of those you supervised. If you do not possess this experience, enter N/A.
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