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#17-006096-0001
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.


1.

Describe your experience in implementing quality assurance initiatives, including Continuous Quality Improvement. In your description, please include the job duties performed, the name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.

2.

Describe your knowledge and experience in reviewing and improving data collection tools to increase program performance and efficiency. In your description, please include the job duties performed, the name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.


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