Montezuma Elementary School
103 W. Sunnyside Ave.
PO Box 355
Montezuma, KS 67867
Phone: 620-846-2283
Fax: 620-846-2294

(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ 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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