**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 in Nursing, Social Work, Psychology, Education, Counseling or a related field?
Yes
No
2.
What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.
3.
Describe your professional experience related to the treatment and services for mentally ill patients. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
4.
Describe your professional health services experience.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
5.
Describe your knowledge of and/or experience with Medicaid systems and billing.
This experience must also be included on your application.
6.
Describe your experience working with transition age youth and young adults. This experience should also be included in your application. If you do not possess this type of experience, indicate N/A in the text box below.
Department of Budget and Management