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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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**



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

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.  

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