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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.***


Describe your experience providing career counseling and case management.  Include employer, job duties, and dates of employment.  If no experience, indicate N/A.


Please describe your experience in the Vocational Rehabilitation and/or Human Services related field. Include in your response the name of employer(s), dates of employment, and relevant job duties. If you do not have this experience, enter N/A.


Do you have professional experience working with students with disabilities? If yes, 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 no experience, indicate N/A.



Describe your experience preparing others for employment using job seeking tools and resources.  Include employer, job duties and dates of employment.  If no experience, indicate N/A.

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