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#19-002772-0001
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 Master's degree from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
2.

Do you possess a Bachelor’s degree from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
3.

If you do not possess a Bachelor's degree in Public Health Education, Community Health Education, or Health Science, do you possess a Bachelor's degree in another field with a minimum of 18 credits hours in Public Health Education, Community Health Education, Health Science, or a related behavioral science? 

Yes No
4.

If yes, please list the required coursework (18 credit hours in Public Health Education, Community Health Education, Health Science or related behavioral science) in the space below using the following format.  You must also attach a copy of your official or unofficial transcripts to your application:

Example:  Course Number   Title                                                 Credits Earned

                     HEA  317          Community Health Interventions                3.0 

* This information will be verified upon employment


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 experience planning, developing, implementing, promoting and evaluating public health education programs.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

7.

Describe your experience managing community health education projects. 

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.

8.

Describe your experience at the supervisory level of planning, developing, implementing, promoting and evaluating community health education work.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

9.

Describe your previous experience in unintentional injury prevention.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

10.

Describe your background in public health.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

11.

Describe your experience in procurement and contract monitoring.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

12.

Describe your experience with writing grants, doing position papers for legislation, and/or writing State or federal reports.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.


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