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#21-001084-0002
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 have a Bachelor's degree in Biochemistry, Biology, Biotechnology, Chemistry, Genetics, Immunology, Microbiology, Molecular Biology, Medical Technology, Pharmacology or Zoology from an accredited college or university?

Yes No

 

If you responded YES to the above question, please upload a copy of your transcript(s) to the application. Unofficial version(s) of the transcript(s) are accepted.


2.

In which field of study is your degree? If you do not have a degree, enter N/A.

3.

Describe your experience with clinical specimens.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

4.

Describe your experience with quality assurance and CLIA regulations.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

5.

Describe your experience in qPCR and other molecular platforms for infectious disease in a BSL-2 lab.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.


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