**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 current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?
Yes
No
2
Please provide your license number and expiration date in the box below.
3
Describe your experience as a community health nurse.
Include name of employer, job title, dates employed, and hours worked per week for each relevant position. If you do not have this experience, put N/A in the box below.