Official SealDepartment of Budget and Management


#18-002721-0009
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a Bachelor's degree in Nursing, Social Work, Psychology, Education, Counseling or a related field?

Yes No
2.

Do you possess a Bachelor's degree in another field other than described above?

Yes No
3.

If you responded YES to the above question, what field is your Bachelor's degree in?

4.

Do you possess a Master's degree in health or human services?

Yes No

5.

If you responded YES to any of the above questions, please upload a copy of your transcript(s) to the application.  Unofficial transcript(s) are acceptable.


6.

Describe your clinical experience with youth ages 8 - 14.

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 you do not possess experience in this area, put N/A in the box below.

7.

Please select the Maryland license that you possess:

Licensed Clinical Professional Art Therapist
Licensed Graduate Professional Art Therapist
Licensed Clinical Professional Counselor
Licensed Graduate Professional Counselor
Licensed Graduate Social Worker
Licensed Clinical Social Worker - Clinical
None of the Above

Powered by JobAps