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#21-007227-0001
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

Please describe your managerial experience in civil rights and anti-discrimination work or a closely related field including employer name, dates of employment, and job duties.  If you do not have this experience please enter N/A. 

2

Please describe previous government agency experience including employer name, dates of employment, and job duties.  If you do not have this experience, please enter N/A.

3

Please describe your experience in establishing and maintaining relationships with key stakeholders to include Federal, State and local partnerships including employer name, dates of employment, and job duties.  If you do not have this experience please enter N/A.


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