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#20-008998-0015
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 a bachelor's degree in emergency management, health services, emergency medical services, education or related discipline? Please indicate the discipline below.

2

Do you have (3) years of experience in developing and delivering training courses and applicable exercise programs?

Yes No
3

Do you have experience in consensus building in a multidisciplinary and/or multi-jurisdictional environment? If so, please describe your experience in detail.  If you do not have experience in this area, indicate N/A.

4

Do you have experience in developing lesson plans and curriculum for trainings? If so, please describe your experience in detail.  If you do not have experience in this area, indicate N/A.

5

Are you certified as a trainer or instructional designer?

Yes No
6

Please describe your experience in creating training exercises to assess the capabilities of participants. If you do not have this type of experience, indicate N/A.

7

Please describe your experience as a responder in law enforcement, fire, EMS, public health, emergency management, or a hospital setting. If you do not have this type of experience, indicate N/A


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