Portland Public Schools Head Start503 916 57244800 NE 74th avenuePortland, Oregon 97218www.pps.net/head-start
Child Date of BirthFormat: yyyy-mm-dd 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: YYYY-MM-DD
Weeks Premature (put "0" if not premature)
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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. For more information please review the privacy policy found here.
By completing this screening, you are giving your consent to Portland Public Head Start to obtain and review this developmental screening.
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.