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#20-002419-0002
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

Describe your experience evaluating, analyzing, researching and developing health care services, policies, and programs.

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

2

Describe your experience with public health, specific to overdose prevention, opioid prescribing or interventions targeting health care providers.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

3

Describe your project management experience (i.e., developing project timelines and plans, creating and maintaining project metrics tracking mechanisms).

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

4

Describe your program evaluation and reporting experience (i.e., evaluating efficiency of operations, developing, revising and recommending new policies, creating and maintaining program SOP's).

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

5

Describe your experience organizing, implementing and administering health care provider communication.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

6

Describe your experience working in or with local health departments.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.


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