EARLY LEARNING COALITION OF FLORIDA'S GATEWAY, INC.
386-752-9770 or 866-752-9770
1104 S.W. Main Blvd.
Lake City FL 32025
www.elcgateway.org

Dear Parent/Guardian

Welcome to the Early Learning Coalition of Florida's Gateway, Inc. web access page for parents/guardians.  We're happy you've chosen to complete your child's ASQ-3 questionnaire and submit the results to us online.

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 an Ages & Stages Questionnaires, Third Edition (ASQ-3), online screening to help you keep track of your child's development.  The questionnaire may be provided at every 6 or 12-month intervals.  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 (if that applies) below to start the screening process.  Please note that the information you enter into the website is secure and cannot be seen or accessed by anyone other than the program staff who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!

Sincerely,

 

Stephanie Barnes,  Child Development/Inclusion Coordinator
Early Learning Coalition of Florida's Gateway, Inc.
1104 S.W. Main Blvd.
Lake City FL 32025
386-752-9770  or 866-752-9770

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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)


I authorize the Early Learning Coalition of Florida's Gateway (ELC-FG), Inc. and/or staff at contracted School Readiness (SR) and/or Voluntary Prekindergarten Program (VPK) sites to administer screenings and/or assessments for my child/children.  I certify that I am the parent or guardian of this child.  I understand that I will be informed of all results from these screenings and/or assessments.  I also understand that these screenings and/or assessments are deemed necessary or advisable by the State of Florida and/or the ELCFG.  With this document, the ELCFG has my permission to release screening and/or assessment information and results to my child's SR and/or VPK provider, the Florida Diagnostic and Learning Resources System (Child Find/FDLRS), Early Steps and any other diagnostic agency as necessary.  I certify that I am legally responsible for this child.  I understand this information will remain confidential and will be used solely for the benefit of my child.  This consent is effective for one year from the date of assessment.

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.