Early Learning Coalition of Lake County
1300 Citizens Blvd. Suite 206
Leesburg, Florida 34748

Jessica Mullins, Child Development Coordinator

(352) 315-6685

For more information about the Early Learning Coalition or about the ASQ Screener, please contact us at (352) 435-0566, Monday - Thursday, 8:00am - 5:00pm.

(put "0" if not premature)

For ASQ:SE-2™ English

For ASQ-3™ English

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.

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