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#19-002084-0001
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.***


1.

Do you have six (6) months of experience working with groups of children or youth in a structured environment, such as a recreation center or school setting?

Yes No
 

If yes, please provide dates, name of employer and describe your experience.


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