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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.***


Please indicate your American Sign Language skill level:

Polite (able to greet and exchange pleasantries; indicate or understand an emergency)
Literate (understands a conversation and can respond)
Fluent (is your native language or can converse in the language as if it was your native language.)
Do not speak sign language.

Do you have experience working with Deaf and hard of hearing students with multiple disabilities, including Autism Spectrum Disorder and Intellectual Disability?  If yes please explain in detail. If no write N/A


Do you have knowledge and experience with counseling theory, principles, ethics, and evidence-based practices? If so, please explain. If not, enter N/A.

Yes No

Do you have knowledge and experience with Tier 1 (school-wide) interventions and universal preventative mental health programming?  If so, please explain. If not, enter N/A.


Do you currently possess certification as a School Counselor through the Maryland State Department of Education (MSDE)? If yes, please attach a copy of your certification with your application, if available.

Yes No

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