Lynhaven Elementary
881 South Cypress
San Jose, California 95117
https://lynhaven.campbellusd.org

 

Dear Parent/Caregiver:

Welcome to our screening and monitoring program. Because your child’s first 5 years of life are so important, we want to help you provide the best start for your child. To support your child's educational experience, we provide the Ages & Stages Questionnaires®, to help you keep track of your child’s development. Regular screening provides a fast and helpful look at how your child is doing in important areas like communication, social skills, motor skills, and problem-solving skills. Screening can identify your child’s strengths, uncover new milestones to celebrate, and reveal any areas where your child may need support. It helps you understand your child’s development and know what to look for next. And it helps you work with your child’s teachers to plan next steps when it makes the most difference—your child’s critical first years of life. 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, social emotional, and personal-social skills.  This screening is optional. 

Please complete your student’s questionnaire by the due date provided by your student’s teacher.  Your student’s teacher will follow up with you regarding your screening. 

We look forward to your participation in our program! 

Sincerely,

 

Campbell Union School District



(put "0" if not premature)



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.

 

As a parent/guardian of the named student in this questionnaire, I authorize release of health and educational information provided in the Ages and Stages Questionnaire screening information and results. Information includes parent contact information, school site and teacher contact information to support exchange of confidential information between Campbell Union School District and the Catholic Charities of Santa Clara County Sherman Oaks Family Resource Center to conduct follow up support and referrals for services related questionnaire responses.  These actions may include providing screening results, information and or resources for any areas of concern, and supporting with follow up screenings or referrals for developmental assessments.  The person or organization who receives the health and/or educational information authorized on this form may only use it for the following educational purpose: Planning and Eligibility.  This authorization shall become effective immediately and shall remain in effect for one year from the date of signature.  This authorization is also subject to written cancellation by the parent/guardian at any time. The written cancellation will be effective upon receipt. Cancellation will not apply to actions taken based on information obtained from prior authorization(s).  To cancel authorization, please email Emalie McGinnis ([email protected]), Director of Data Analysis and Accountability. I understand that the recipient may not lawfully further use or release the information unless another authorization is obtained from me or unless such use of release is specifically required or permitted by law.

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.