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#21-001026-0004
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 from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
2

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

3

If you do not have a Bachelor's degree in Public Health Education, Community Health Education, or Health Science, do you have a minimum of 18 credits hours in Public Health Education, Community Health Education, Health Science, or a related behavioral science? 

If you answered "yes" to this question, a copy of your transcripts (official or unofficial) must be submitted with your application to receive credit. 

Yes No
4

Bilingual applicants are encouraged to apply.

Are you able to speak, read and write in both English and another language?

Yes No
5

If yes, please list the languages that you can speak fluently.

6

Describe in 1-3 paragraph(s), your direct experience in planning, evaluating and delivering health education/promotion programs in virtual and in-person community settings.

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.

7

Describe in 1-3 paragraph(s), your direct experience in building capacity among individuals, families, groups and communities to access health care/social service resources.

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.


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