***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***
1
Do you possess a current certificate as a Nurse Practitioner or as a Nurse Midwife from the Maryland State Board of Nursing?
Yes
No
2
Do you currently possess a current Nurse Practitioner certification (Pediatrics or Family)? If so, please identify which certification you possess. If you do not possess a certification, type N/A.
3
Are you CPR/AED certified?
Yes
No
4
Do you have one year of experience as a board-certified nurse practitioner in Pediatrics or Family? Please describe your experience. Include employer name, employment dates, hours worked per week. If no, type N/A.
5
Do you have one year of clinical supervision or management experience? Please describe your experience. Include employer name, employment dates, hours worked per week. If no, type N/A.
Department of Budget and Management