Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

I give the Van Buren ISD consent to read my child's screening results and contact me regarding any supports or resources that would be helpful to give my child a great start. I also give the Van Buren ISD permission to use my child's score in a compiled list to show county data results. The compiled list will not identify my child by name, address or any other specific identifying information. 

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