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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.**



The education requirements for the Associate level Alcohol and Drug Counselor are as follows:

Bachelors degree or higher in Human Service counseling field from a regionally accredited college or university.

33 semester credits (50 quarter credits) of alcohol and drug coursework.

 Required courses:

3 sem cr (5 qtr cr) must be in the areas below:

a. Medical aspects of chemical dependency (Pharmacology)

b. Addictions Treatment Delivery

c. Ethics that includes alcohol and drug counseling issues.

d. Group counseling

e. Individual counseling

f. Abnormal Psychology


g. Six (6) semester credits (10 quarter credit) in alcohol and drug internship/practicum or field placement.


AND any 3 of the following 3 semester credit (5 quarter credit) courses from the areas below:

h. Family counseling

i. Theories of Counseling

j. Human Development

k. Topics in substance related and addictive disorder

l. Treatment of cooccurring disorders.


Do you possess the required education as defined above?

Yes No


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


This is a full-time contractual evening shift position in which the applicant must be willing to work 4:00 pm to 12:30 am on a regular basis.  Are you willing to work this evening shift?

Yes No

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