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#17-001905-0002
Supplemental Questionnaire

Last Name
First Name
1.

Describe your experience in a long-term services and supports program.  Include employer, dates of employment, job duties and number of hours per week these duties were performed.  If no experience, indicate N/A.

2.

Describe your experience providing technical assistance and training.  Include employer, dates of employment and job duties.  If no experience, indicate N/A.

 

3.

Describe your experience conducting oversight and monitoring activities.  Include employer, dates of employment and job duties.  If no experience, indicate N/A.


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