Oberlin Kids Community Collaborative
440-371-0113
[email protected]
23 Eric Nord Way
Suite 2
Oberlin, Ohio 44074
www.OberlinKids.org

Welcome to our On Track for Kindergarten Check-In screening program!

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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)



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.

 

OberlinKids Confidentiality Statement

Your privacy matters to us. Information collected by OberlinKids helps us better understand and support your child and family.  Non-identifying information may be used for overall program review and data reporting. Personal information is kept confidential and will never be shared outside of the OberlinKids Collaborative without your knowledge and consent, including when connecting your family with requested services or resources.

OberlinKids Community Partners are bound by Collaborative confidentiality requirements designed to protect the privacy of information stored in Collaborative databases or discussed as part of service coordination and referrals. This allows OberlinKids to:

  • Improve services and provide individualized support based on each family’s needs.

  • Identify appropriate resources while reducing duplicate data collection for families.

  • Use non-identifying information to track program outcomes, identify unmet needs, allocate resources, plan services, report the Collaborative’s progress to the community, and support funding opportunities.

You have the right to:

  • Review or request a copy of your or your child’s information at any time.

  • Refuse to answer questions you consider sensitive; however, some information may be required to determine eligibility for specific services.

  • Have your or your child’s identifying information kept confidential. Identifying information will not be released to individuals or organizations outside of the OberlinKids Collaborative without your knowledge and consent, except when disclosure is required or permitted by law as described below.

A current list of OberlinKids Community Partners is available at oberlinkids.org/partners. All participating Community Partners have agreed to OberlinKids confidentiality requirements and have a current Memorandum of Understanding on file with OberlinKids.

 

Certain information may be disclosed without your authorization when required or permitted by law, including in response to a court order, medical emergency, government audit, suspected child abuse or neglect, or when necessary to prevent serious, foreseeable, or imminent harm. Access to identified information is limited to authorized individuals with appropriate access and confidentiality training.

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.