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#21-003643-0003
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 Master's degree in the field of Public Health from an accredited college or university with a minimum of three graduate courses in Epidemiology and one graduate course in Biostatistics?

Yes No
2.

If yes, please list the required coursework (three graduate Epidemiology courses and one graduate course in Biostatistics) in the space below using the following format.  If no, please indicate N/A. You may also attach a copy of your official or unofficial transcripts to your application:

Example:  Course Number        Title                                    Credits Earned

                     EPI 101            Introduction to Epidemiology        3.0 

 

*This information will be verified upon employment.  

3.

When did you earn your master's degree (please indicate the month and year)?

4.

Do you possess a Doctoral degree in the field of Public Health from an accredited college or university with a minimum of six graduate courses in Epidemiology and three graduate courses in Biostatistics?   If yes, please submit a copy of your transcripts (transcripts may be unofficial) with your application.  Failure to include your transcripts may result in disqualification.

Yes No
5.

Describe your experience as an epidemiologist.

Include name of employer, job title, dates of employment, and hours worked per week for each relevant position. If you do not have this experience, put N/A in the box below.

6.

Describe your experience using SAS software to manipulate and perform statistical analysis of health data.

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.

Describe your experience using ArcGIS software to map health data.

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.


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