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#20-000672-0001
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Do you possess a Master's Degree from an accredited college or university?

Yes No
2

What field of study is your master's degree in?

3

Describe your professional experience in public health or health services.

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 experience in epidemiology, statistics, and/or program evaluation in a public health or health services field.

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 experience at a managerial or supervisory level.  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.

6

Describe your proficiency level in SAS (Statistical Analysis Software).  

If you do not possess experience in this area, put N/A in the box below.


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