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#21-002589-0036
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 how have you identified, developed and maintained outreach opportunities including employer name, dates of employment, and job duties.  If you do not have this experience please enter N/A.  

2

Describe what outreach methods would you use to communicate to the Hispanic, Black and young adult (18-34) audiences?

3

How have you integrated outreach as part of a marketing strategy to encourage behavior change or inspire action?  Please include in your response employer name, dates of employment, and job duties.  if you do not have this experience please enter N/A. 

 

4

Please explain your knowledge of and experience with health care, insurance and/or the Affordable Care Act.  Please include in your response employer name, dates of employment, and job duties. If you do not have this experience please enter N/A. 


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