Christina School District
620 E. Chestnut Hill Rd.
Newark, Delaware 19713

(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

By completing this questionnaire, you give Christina School District consent to:

-Review and score your child's screening results, and contact you via phone, email, and/or US mail with the results of your child's screening.

-Share your child's screening results with your current preschool/childcare, your home/feeder school district, Delaware Department of Public Health, the Delaware Department of Education, and if applicable, with DE 211/Help Me Grow.

-If warranted, speak with you about a referral for additional testing, then assist you with making a referral to Child Development Watch (CDW), your district of residence, and/or the district in which your child care/preschool is located.


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