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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.**



Do you possess a Bachelor's degree in Nursing, Social Work, Psychology, Education, Counseling or a related field?

Yes No

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


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


Please outline the work or experience you have which includes support services and programs for individuals with intellectual disabilities and/or other developmental disabilities.  Detail duties and the dates these duties were performed.  Give specific details.


Describe your knowledge of and/or experience with DDA Programs and Eligibility and Waiver Systems.

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.


Describe your experience with customer service.

Do not copy and paste from your resume. 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.


Please describe your experience preparing and using Excel spreadsheets. Please include the name of the employer, dates of employment and hours worked per week.  This information must also be included in the application.  If you do not have this experience, please indicate N/A.

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