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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.***


Please describe your experience performing secretarial or clerical work involving typing duties.

Include details pertaining to how much typing was required and the type of work that required typing.  Please also include details regarding software applications/computer use, job title, employer name, dates of employment, and hours worked per week. If you do not have this experience, please indicate N/A.


Describe your experience in a clinical setting serving children, adolescents and families in a mental health/addictions treatment setting.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

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