Department of Budget and Management

***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 have a license from the Maryland State Board of Professional Counselors and Therapists as a Licensed Clinical Professional Counselor? If you do possess the appropriate license, then please submit a copy of your license with your application.

Please describe your experience working with an adolescent population with mental health and or substance abuse issues. Please include the setting and type of interventions or treatments you applied. Provide the name of the employer(s) and dates you performed this responsibility and hours per week. If no experience, indicate N/A.

Please describe your experience assessing and providing therapy to a population of adolescents in the juvenile justice system with mental health or substance abuse disorders. Provide the name of the employer(s) and dates you performed this responsibility and hours per week. If no experience, indicate N/A.