Collaborative for Educational Services
413-586-5568
ebouvier@collaborative.org
97 Hawley Street
Northampton, Massachusetts 01060



(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

CFCE Ages and Stages Questionnaire and Parental Consent

The Department of Early Education and Care (EEC) is focused on ensuring that all children in Massachusetts have access to developmental learning opportunities, and that parents and families are provided with knowledge and resources to support their role as their child's first teacher. EEC's Coordinated Family and Community Engagement (CFCE) grantees work directly with parents and families to provide these learning opportunities for young children. One of the developmental learning activities used by CFCE grantees is the Ages and Stages Questionnaire (ASQ) developmental screening tool. This tool allows for families to learn more about their child's progress along five developmental domains, as well as what they can do to support their child's growth at home. CFCE staff are available to assist families with ASQ screening and can provide information, resources, and referrals based on the child's scores. 

To ensure that EEC's policies and programs reflect the needs of programs and families, CFCE staff may enter your child's screening information into the ASQ Online database. EEC staff uses aggregate, or totaled, information to determine screening trends, future trainings for CFCE providers, and policies. Aggregate scores tell EEC how many children have been screened within a certain time period, the average age of when Massachusetts children are screened, or if the ASQ English or ASQ Spanish was used. Your child's information and screening scores will never be analyzed or shared at the individual level. If you do not wish to have this information entered online, you may decline this option and still have you child screened with the ASQ tool. 

Please read the text below and click “Submit” to indicate that you and your child agree participate in the ASQ screening:

I acknowledge that I have read the information provided by the CES Early Chidlhood Department about the ASQ screening tool:

I agree to have my child screened with this tool to learn more about their developmental progress; and

I agree to have my child's screening information entered into the ASQ online database.

If you would rather complete a paper ASQ, please contact Emily Bouvier at ebouvier@collaborative.org for a paper copy.

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.