Golden Prairie Parent Link
403-443-3064
assistant@goldenprairieplc.ca
Box 400
779 2nd St. N.
Three Hills, Alberta T0M 2A0
www.goldenprairieplc.ca

Welcome to the Ages & Stages Social Emotional online questionnaire. Thank you for taking the time to learn about your child's social emotional development and to complete the online questionnaire. We hope you find this tool helpful in understanding your child's strengths and areas of weakness.

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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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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:SE-2!



(put "0" if not premature)

By completing the questionnaire on the next pages you hereby give permission to the Parent Link Family Coach to contact you to review the results of your child's questionnaire.

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.