**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 from an accredited college or university in, public health, nursing, social work, psychology, counseling or health related field?
Yes
No
2
Describe your professional experience in health services. Health services is defined as experience in areas other than Mental Health, Developmental Disabilities or Addictions.
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.
3
Describe your professional work experience related to the support services and programs for developmentally disabled clients.
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.
4
Describe your experience with medicaid waiver programs.
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.
5
Describe your knowledge of and/or experience with CMS Home and Community Based Settings Criteria.
This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.
6
Describe your training and experience with Person Centered Planning.
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
Describe your knowledge of and/or experience with DDA Policy on Reportable Incidents and Investigations.
This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.
8
Describe your knowledge of and/or experience with COMAR related to DDA services.
This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.
Department of Budget and Management