Training Advisor Questionnaire

The Medicaid Integrity Institute (MII) relies on subject matter experts in the field of Medicaid healthcare fraud to advise instructional design and development staff and to contribute input and content for MII training programs. Motivated and diverse training advisors (TAs) are vital to achieving the goals of the MII.

TAs can participate in any of a variety of capacities including: subject matter experts, course content and material developers, and faculty advisors and members. If you are interested in participating as a MII TA, please complete the short questionnaire below and return to the MII. The MII tries to match TAs knowledge, skills, and experience with the variety of tasks needed to complete ongoing training.

Name: Title: State: Email Address: Phone Number:

What is your subject matter area of expertise and or interest? Please describe your professional/work experience in this area. Within your area(s) of subject matter expertise or interest, in what capacity would you be interested in participating? place an x beside all areas of interest Presenter/Lecturer in large group classroom setting

Group Leader/Facilitator in small group breakout session

Developing and Drafting Course Content and Materials

Course Content and Materials Reviewer/Editor

Research and Analysis

Comments:

Have you had any experience teaching or instructing? If so, to what type of audience, where, and when?

Do you have any public speaking experience? If so, please describe.

Briefly describe your work experience in Health Care Fraud and Medicaid Program Integrity efforts. Thank you for your responses!

Email: [email protected] Mailing Address: MII – NAC 1620 Pendleton Street Columbia, SC 29201