Official SealDepartment of Budget and Management


#18-002820-0015
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.

Do you possess a bachelor's degree from an accredited college or university in public health, public policy, or related field?

Yes No
2.

What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.

3.

Do you possess a master's degree from an accredited college or university in public health, public policy, or related field?

Yes No
4.

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

5.

Describe your professional experience in health services.  Health services is defined as experience in areas other than Mental Health, Developmental Disabilities or Addictions.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below. 

6.

Describe your professional federal grant management experience as it relates to the Maternal and Child Health (MCH)/Maternal, Infant and Early Childhood Home Visiting (MIECHV) programs, or an accredited home visiting program.

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.

7.

Describe your professional experience in budget monitoring and tracking expenditures, contract preparation, performance monitoring, and/or oversight.

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.

8.

Describe your professional experience with grant writing, as well as your experience communicating with program evaluators or university personnel.

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.

9.

Describe your professional experience with performance monitoring and continuous quality improvement efforts.

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.


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