**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 Nurse Practitioner or Nurse Midwife from the Maryland State Board of Nursing? If yes, please submit a copy of your license or include the license number and expiration date on your application.
Yes
No
2.
Please provide your license number and expiration date in the box below.
3.
Describe your experience in women's health clinic, including performing women's annual exams.
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.
Do you possess certification for insertion and removal of long-acting reversible contraception?
Department of Budget and Management