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#19-000484-0011
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

 Explain your experience dealing with STI and HIV case management?

2

Explain your experience with disease investigation?

3

 Do you have experience with referrals?

4

Explain your experience maintaining, preparing, and presenting reports?


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