Family Futures
678 Front Ave NW - Ste 210
Grand Rapids, Michigan 49504

Thank you for participating in the Connections program of Family Futures!

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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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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:SE-2!

(put "0" if not premature)

Thank you for submitting your Connections ASQ:SE-2 information online! I will let Family Futures share my ASQ results and other information with their partners to build a stronger circle of support for my family. I will let Family Futures share information with funding providers. If you are a Kent County resident, this includes the Ready by Five Millage Consent. I will let Family Futures use my information for basic research. Family Futures will not print information that could identify my child in any public reports. This agreement does not have an end date. I can stop Family Futures from sharing my information at any time and for any reason by sending a written letter. Doing this will not change services received.

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.