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#21-000658-0002
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 current license as a Dietitian or Nutritionist from the Maryland State Board of Dietetic Practice? If YES please include your license number and expiration date in text box.  Also, please upload copy of license to your application.

2.

Please describe your experience providing professional nutrition or dietetic services within a public health or community setting.  This experience must also be included in your application.  If do not possess this type of experience, please indicate N/A in the text box.

3.

Please describe your supervisory experience.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised.  If you do not possess this experience, enter N/A.

4.

Describe in 1-3 paragraph(s), your one year of experience managing and promoting the Women, Infants and Children (WIC) Program.

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.

5.

Describe in 1-3 paragraph(s), your experience managing a Public Health Nutrition Program.

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.

6.

Describe in 1-3 paragraph(s), your experience/familiarity with Federal Regulations related to Managing Public Health Programs.

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 experience developing budgets, tracking expenditures, staff recruitment and management.

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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