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#23-009405-0001
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 Bachelor’s degree (or higher) from an accredited college or university?

Yes No
2.

If you responded YES to the above question, please specify what field or major your degree is in the space provided below? If no degree, enter N/A.

3.

Do you possess at least ten (10) years of professional experience working with executive leadership?

Yes No
4.

Please describe your experience working with executive leadership below. Include in your response the employer name(s), hours worked, and dates of employment. If you do not possess this experience, please indicate N/A in the space below.

5.

Do you possess at least five (5) years of professional experience working with youth under court supervision or in youth justice, alternative community placements, or equivalent direct service experience with youth?

6.

Please describe your experience working with youth under court supervision or in youth justice, alternative community placements, or equivalent direct service experience with youth below. Include in your response the employer name(s), hours worked, and dates of employment. If you do not possess this experience, please indicate N/A in the space below.

7.

Please describe your professional experience with designing and implementing diversity, equity, inclusion, and engagement initiatives in the space provided below. Include in your response the employer name(s), job title, dates of employment, and hours worked per week. If you do not possess experience in this area, put N/A in the box below.

8.

Please describe your professional experience and knowledge of community reinvestment strategies and implementing initiatives and programs grounded in positive youth development in the space provided below. Include in your response the employer name(s), job title, dates of employment, and hours worked per week. If you do not possess experience in this area, put N/A in the box below.

9.

Please describe your professional experience with developing a team and organizational strategy and being accountable for its results in the space provided below. Include in your response the employer name(s), job title, dates of employment, and hours worked per week. If you do not possess experience in this area, put N/A in the box below.


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