Zero to School 

Welcome! By completing this questionnaire, you consent to your responses being shared with Zero to School and your local school to help plan programs and support children and families. After you complete both short questionairres, you will receive and email within a week from our Zero to School coordinator with specific feedback about your child's results. If you have any questions in the meantime, feel free to reach out to your local school's office or email: Jess Berry at [email protected] or Marlie Reny at [email protected].

 

Please click 'I am completing both the ASQ-3™ and ASQ:SE-2™ questionnaires'. button. The site will prompt you to move directly onto the second one once the first is completed. 

Child Date of Birth

Month Day Year

MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026

Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: MM-DD-YYYY

Weeks Premature
(put "0" if not premature)

Screening Date Options

For ASQ-3™ English

Screening Date

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date

List others assisting with completion of the questionnaire

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online 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.

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.