Pulaski Community School District
920-822-6021
[email protected]
143 W Green Bay St
Pulaski, Wisconsin 54162

Welcome to the Pulaski Community School district screening and monitoring program. The Pulaski District is committed to providing comprehensive early intervention services. The first step in this process is the completion of the online Ages and Stages Questionnaire. We are excited to have this opportunity to learn more about your child!

Your child's firt 5 years of life are so important, we want to help you provide the best start for your child. You are invited to participate in the Ages & Stages Questionnaires (ASQ-3), to help keep track of your child's development. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills. We feel it is important to point out that you should not expect your child to answer every question correctly. Some questions will be easy and some will be difficult. Just encourage your child to do the best job possible and enjoy the time you spend together.   The information completed on the Ages and Stages questionnaire will be used to screen your child's development in these areas.          

You will receive a follow-up letter letting you know if your child's development appears to fall within the expected range at this time.  If any areas of possible concern or questions would emerge, you will recieve a phone call to talk about this further.

Please enter your child's birth date and the number of weeks he or she was born premature (enter "0" if child was born on time) 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 Pulaski School District  program employees who have invited you to particpate in this screening.

*NOTE: On the next screen you will be prompted to complete three steps. While you may wish to follow the instructions, please feel free to print, complete the questionnaire with your child and send a hard copy to the following address if that would be more convenient for you:

Pulaski Community School District, 143 W Green Bay St, Pulaski WI 54162, Attn: Student Services Department

We look forward to your participation in ASQ-3!

 

 *Please disregard this automated section- GO TO "Child Date of Birth" below.  

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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)


PLEASE NOTE: by clicking the submit button (below) you are giving your consent to participate in the screening/monitoring program, if you do not wish to participate you need not do anythnig further . 

____ I have read the provided information about the Ages & Stages Questionnaires (ASQ-3), and I wish to have my child(ren) participate in the monitoring program. I will fill out the questionnaires about my child's development and promptly return the completed questionnaires through the online questionnaire completion system.

____ I do not wish to participate. I have read the provided information about the Ages & Stages Questionnaires (ASQ-3) and understand the purpose of this program.

Parent/Guardian Signature

Please Print Parent/Guardian Name

Date

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.