**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 with 30 credit hours in mental health, health, human services, education, or related behavioral sciences, including six credit hours in psychology, counseling, addictions or mental health? If you respond YES to this question, please attach your transcript(s) to your application.
Yes
No
2.
Do you possess a Master's degree from an accredited college or university in mental health, health, human services, education, or related behavioral sciences? If you respond YES to this question, please attach your transcript to your application.
Yes
No
3.
Describe your work experience coordinating and providing distinct interventions unique to the individual physical, mental, learning and social development and therapeutic treatment needs of seriously mentally ill children and adolescents in a therapeutic mental health setting. This experience must also be presented in your application. If you do not possess this type of experience, indicate N/A in the text box below.
4.
Describe your work experience planning and implementing therapeutic recreational activities that focus on community integration. If you do not possess this type of experience, please indicate N/A in the text box below.
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