Department of Budget and Management

**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.**

Are you currently licensed to practice medicine by the Maryland Board of Physicians?  (If Yes, please submit a copy of your license or license verification with your application.)

If you answered yes, please attach a copy of your license to your application.  Also, provide the license number and expiration date below.

Describe your experience in the treatment of children and adolescents in behavioral health care which includes program management and supervision of clinical and administrative staff. 

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.

Describe your knowledge of Maryland's public behavioral health systems of care to children and adolescents including inpatient psychiatric services and Medicaid.

Describe your experience with data driven decision making, clinical research methodology, and financial management including value based contracting.

With your description, please include name of employer, job title, dates of employment and hours worked per week for each relevant position.  This information must also be reflected on your resume or application.