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#20-002071-0005
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 Bachelor’s degree from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
2

If you do not have a Bachelor's degree in Public Health Education, Community Health Education, or Health Science, do you have a minimum of 18 credits hours in Public Health Education, Community Health Education, Health Science, or a related behavioral science? 

If you answered "yes" to this question, a copy of your transcripts (official or unofficial) must be submitted with your application to receive credit. 

Yes No
3

Do you posses a master's degree in public health or a related field from an accredited college or university?

Yes No
4

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

5

Describe your experience planning, developing, implementing and promoting health education projects. 

Include name of employer, job title, dates employed, and hours worked per week for each position that demonstrates this experience.  If you do not have this experience, put N/A in the box below.

6

Describe your experience coordinating and directing a public health education program.

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.

7

Describe your experience working in public health at the federal, state or local level and in a high pressure setting with time-sensitive demands.

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.

8

Describe your experience creating and delivering training programs.

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.


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