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#19-002711-0002
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 or higher from an accredited college or university?

Yes No
2

Describe your experience with the Maryland Children's Health Insurance Program (MCHP).

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.

3

Describe your experience verifying client information through the SAVE Program. This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box.

4

Describe your experience with Maryland Health Connections.

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

5

Describe your experience in the review and evaluation of staff work to maintain adherence of Maryland State regulations for insurance eligibility.  This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box.


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