Early Childhood Partners/CFCE of Hamilton-Wenham & Manchester 

Program Coordinator: Lisa Cheney, M.Ed.

130 Essex Street, Hamilton, MA 01982

978-468-5489

e.cheney@hwschools.net

www.EarlyChildhoodPartners.weebly.com

 

Welcome to the Early Childhood Partners/CFCE of Hamilton-Wenham & Manchester online version of the Ages & Stages Questionnaire. If you have any questions, call Lisa Cheney at 978-468-5489 or email at e.cheney@hwschools.net.

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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)

Appendix J: ASQ Consent Form

 

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 check the box to indicate whether you and your child agree participate in the ASQ screening:

I acknowledge that I have read the information provided by Early Childhood Partners/CFCE of Hamilton-Wenham & Manchester 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. 

I acknowledge that I have read the information provided by Early Childhood Partners/CFCE of Hamilton-Wenham & Manchester about the ASQ screening tool:

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

I do not agree to have my child's screening information entered into the ASQ online database. 

I acknowledge that I have read the information provided by Early Childhood Partners/CFCE of Hamilton-Wenham & Manchester about the ASQ screening tool and I decline to have my child screened with the ASQ.

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.