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#19-001560-0002
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 have a minimum of an Associate's degree in a Health or Human Services counseling field OR an  Associate's degree in a program of study with a counseling emphasis AND 1 credit in Alcohol and Drug Ethics?  If yes, you must submit a copy of your transcripts documenting the completed coursework with your application.

Yes No
2
If you answered no to question #1, do you have an Associate's degree in another field plus 15 credits in the following:
 
- Pharmacology of Psychoactive Drugs
- Individual Counseling
- Group Counseling
- Abnormal Psychology
- Addictions treatment delivery
- Human Grown and Development
- Topics in Alcohol and Drug dependency
- Family Counseling
- Theories of Counseling
 
AND 1 credit or 15 CEU's in Ethics with a focus on alcohol and drug counseling?
 
If yes, please submit a copy of your transcripts (transcripts may be unofficial) documenting the completed coursework with your application.
Yes No

 

TRANSCRIPTS ARE NEEDED TO DETERMINE IF APPROPRIATE COURSEWORK HAS BEEN COMPLETED TO QUALIFY FOR THIS POSITION.  FAILURE TO PROVIDE TRANSCRIPTS AT TIME OF APPLICATION WILL RESULT IN DISQUALIFICATION.



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