Department of Budget and Management

***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.***

Do you possess a Licensed Clinical Professional Counselor (LCPC) license? If so please provide your license number and full expiration date. Enter N/A if this question does not apply to you.

Do you possess at least two years of experience assessing and/or providing therapy to a population of adolescents with mental health and/or substance abuse disorders in the Juvenile Justice system? If yes, please describe your experience. Include the employer's name, dates of employment, job duties, and hours worked per week. If you do not have this experience, indicate N/A.

Describe your experience working with an adolescent population with mental health and/or substance abuse issues. Please include your employer's name, the dates of employment, job duties, and the number of hours worked per week. If you do not have this experience, type N/A.