Official SealDepartment of Budget and Management


#21-002721-0006
Supplemental Questionnaire

Last Name
First Name
1

Do you have a Bachelor's degree from an accredited college or university in nursing, social work, psychology, education or counseling?  (This information must be listed on your application in order to receive credit.)

Yes No
2

Describe your professional experience related to the treatment and services for mentally ill patients. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

3

Do you possess a Master's degree in Art Therapy, Counseling, Social Work or related field?

Yes No
4

Describe your supervision of and/or clinical experience with youth aged 8-17.

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 facilitating counseling, therapy, or support groups with youth aged 8-17.

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.

6

Describe your knowledge of the impact of substance misuse disorders and addiction on families or experience providing addiction treatment or recovery services.

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.

7

Which of the following licenses, from the Maryland Board of Social Work Examiners or Board of Professional Counselors and Therapists, do you possess?

LCPAT (Licensed Clinical Professional Art Therapist)
LGPAT (Licensed Graduate Professional Art Therapist)
LCPC (Licensed Clinical Professional Counselor)
LGPC (Licensed Graduate Professional Counselor)
LGSW/LMSW (Licensed Graduate/Masters Social Work)
LCSW-C (Licensed Clinical Social Worker, Counselor)

Powered by JobAps