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#17-002430-0008
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.***


1

Do you possess a current license as a Registered Environmental Health Specialist (formerly Environmental Sanitarian) from the Maryland Board of Environmental Health Specialists (formerly known as the Maryland Board of Environmental Sanitarians)?  If yes, please include a copy of your license with your application.  Indicate your license number and expiration date in the box below. If you do not possess this license, please put N/A in the box below.


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