Official SealDepartment of Budget and Management


#17-003235-0038
Supplemental Questionnaire

Last Name
First Name

1.

Do you have one year of experience in program development for, and/or providing administrative direction or oversight in any of the following areas:
 

a.  Student behavior and disciplinary consequences/alternatives
Yes No
 

b.  School climate and culture
Yes No
 

c.  At-Risk student prevention and intervention strategies and services
Yes No
 

d.  Violence Prevention
Yes No
 

If you answered yes to any of the above questions, describe to include date(s) and location(s)
2.

Do you have any experience with multi-cultural issues and their impact on students and communities?
Yes No
 

If yes, describe to include date(s) and location(s)
3.

Do you have any experience with implementing evidence-based intervention/prevention practices and models?

Yes No
 

If yes, describe to include date(s) and location(s)
4.

Do you have any experience with prevention /intervention programs or initiatives, such as Positive Behavioral Intervention & Support (PBIS), truancy intervention, suicide prevention, conflict resolution or other behavioral support initiatives?
Yes No
 

If yes, describe to include date(s) and location(s)
5.

Do you have experience developing and delivering training?
Yes No
 

 If yes, describe to include date(s) and location(s)
6.

Do you have experience developing policies and procedures, providing leadership and supervision to staff and budget administration?
Yes No
 
If yes, describe to include date(s) and location(s)
7.

Do you have experience with and/or developing surveys or assessments/data collection instruments and analyzing data collected and making recommendations based on data analysis?
Yes No
 
If yes, describe to include date(s) and location (s)
8.

Do you have experience analyzing and interpreting data specifically related to at-risk students as well as behavioral and expulsion data to include the understanding of disproportionality among recognized sub-groups?
Yes No
 

If yes, describe to include date(s) and location(s)
9.

Do you have experience collaborating with local school systems, law enforcement/public safety agencies, government agencies, community organizations and other stakeholders?
Yes No
 

If yes, describe to include date(s) and location(s)

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