**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 with compliance activities which involve the inspection, oversight, audit or review of operational details of a service delivery program. This experience must also be included in your application. If you do not possess this type of experience, please indicate N/A in the text box below.
2
Do you possess a license or certification as a professional counselor, addictions counselor, nurse or social worker?
Yes
No
3
If you responded YES to the above question, please provide your license number and expiration date in the text box below.
Department of Budget and Management