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#21-004314-0004
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 Bachelor's degree with a major in health services, human services, education or the behavioral sciences?

Yes No
2.

What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.

3.

Describe your experience in providing work placement, work training, and work adjustment services to mentally ill patients or developmentally disabled clients in a pre-vocational development program.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must be reflected in your application.  If you do not have this experience, put N/A in the box below.

4.

Describe your knowledge of and/or experience with plant care and production including seeding, watering, pruning, harvesting and growing plants.

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.

5.

Describe your experience managing planned gardening activities in a greenhouse.

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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