(ARCHIVED) Gold Creek Child Development Center
9075861529
[email protected]
PO Box 22010
Juneau, Alaska 99802
www.goldcreekchilddevelopment.com

Welcome to our ASQ Online screening program!

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Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child's development. The questionnaire may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!



(put "0" if not premature)


We are committed to your privacy and the privacy of your child.  The developmental information you enter in ASQ Online may only be viewed by Gold Creek staff that have permission to access your account.  Your child’s name and date of birth may be viewed by the REACH Infant Learning Program Director, since that program supports our use of the ASQ Online.  However, that and all other information is confidential and will only be shared with others with your written consent.  

The State of Alaska Early Intervention/Infant Learning Program (EI/ILP) has provided funding for this project to allow access to developmental screening for all families.  The State EI/ILP staff will be tracking the number of children who are screened but will not be able to view any identifying information.  All collected information is protected under the Family Education Rights and Privacy Act (FERPA) and Health Insurance Portability and Accountability Act (HIPAA).

 

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

Note: By clicking "Submit", you are agreeing to both our Family Access End User License Agreement and any other consent or authorization information outlined on this page.