Official SealDepartment of Budget and Management


#23-002003-0008
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.

Are you currently licensed as an LMSW or LCSW-C?

Yes No
2.

Do you have a background and experience in juvenile and/or mental health and co-occurring disorders?

3.

Do you have experience conducting screening interviews and assessments, or developing service plans?

4.

Please explain in detail your ability to meet internal and external deadlines?


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