Do you possess a Master's degree in a health or human services counseling field?
Yes
No
2.
If you answered yes to the above, please indicate major and total number of credits completed for degree. If you answered no, indicate N/A.
3.
Do you possess a doctoral degree in a health or human services counseling field?
Yes
No
4.
If you answered yes to the above, please indicate major and total number of credits completed for degree. If you answered no, indicate N/A.
5.
If you are not attaching a transcript, indicate total number of credits completed in alcohol and drug counseling training. List title of courses completed. If you are attaching a transcript, indicate N/A.
6.
Have you completed an internship in alcohol and drug counseling that totals six semester credits?
Yes
No
7.
Have you completed a minimum of 1,000 hours of alcohol and drug counseling work completed under and verified by a Board approved alcohol and drug counselor supervisor?
Yes
No
8.
Do you possess a current license as a Licensed Clinical Alcohol and Drug Counselor (LCADC) from the Maryland Board of Professional Counselors and Therapists?
Yes
No
9.
Please describe your clinical supervisory experience. Include job title, employer, duties, dates of employment and number of hours worked per week. If no experience, indicate N/A.
10.
Describe your experience writing and/or managing grants. Include, job title, employer, duties, dates of employment and number of hours worked per week. If no experience, indicate N/A.
11.
Describe your experience working with correctional population and detainee population. If no experience, indicate N/A.
12.
Describe your experience with medication assisted treatment.
13.
Describe your experience providing oversight in a multi-vendor model. If no experience, indicate N/A.
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