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#26-005213-0001
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

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.
2

Do you have experience working with children in a school, hospital setting, critical care setting, or community nursing? If yes, please explain. If no, write “N/A.”

3

Do you currently possess a valid Registered Nurse license from the Maryland State Board of Nursing? If yes, please attach a copy of your license to your application.

Yes No
4

Do you have experience with Google Workspace? If yes, please explain. If no, write “N/A".

5

Do you have experience with PowerSchool or another student information system? If yes, please explain. If no, write “N/A.”


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