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#18-002420-0004
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.

Describe your experience evaluating, analyzing, researching and developing health care services, policies, and programs.

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not possess experience in this area, put N/A in the box below. 

2.

Describe your experience evaluating behavioral health care policy (State or National Level).  This experience should also be reflected in your application.  If you do not possess this type of experience, indicate N/A in the text box below.

3.

Describe your experience writing correspondence and experience utilizing oral communication skills.  Please describe this experience in detail and indicate the length of time and location where you performed these tasks.  If you do not have this experience, please indicate N/A.

4.

Do you possess a Master's Degree from an accredited college or university?

Yes No
5.

What field of study is your master's degree in?


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