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#17-002419-0013
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 Master's degree in Health Sciences, Health Care Administration, Public Health or Public Policy?

Yes No
2.

What field of study is your master's degree in?

3.

Describe your experience evaluating, analyzing, researching and developing health care services, policies, and programs.

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not possess experience in this area, put N/A in the box below. 

4.

Describe your public health experience related to maternal and child health initiatives.

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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