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#21-000484-0020
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

Please selection which option(s) you are interested in:

Option 1 - Prevention Project Coordinator
Option 2 - SUD Youth Outreach Coordinator
2

Describe in 1-3 paragraph(s), your experience networking and engagement skills to identify and recruit participants for the evidence-based programming.

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.

3

Describe in 1-3 paragraph(s), your experience with coordinating substance use referrals and care for youth consumers to community providers.

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.

4

Describe in 1-3 paragraph(s), your experience with data tracking to monitor performance measure progress.

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 with utilizing surveys and other evaluation methods to conduct and analyze a needs assessment that will inform future programming.

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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