**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.
Do you possess a current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?
Yes
No
2.
Please provide your license number and expiration date in the box below.
3.
Describe your experience in a forensic psychiatric setting.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
4.
Describe your experience in a fast-paced ambulatory clinic using medical skills.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
5.
Describe your experience using computer applications and/or Electronic Medical Records (EMRs).
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
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