Official SealDepartment of Budget and Management


#20-000205-0023
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 high school diploma or a high school equivalency certificate?

Yes No
2

Describe your experience with breastfeeding, as well as with conducting breastfeeding education classes. 

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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