Spartanburg Academic Movement
349 E Main St Suite 101
Spartanburg, South Carolina 29302



(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

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.

In addition, I agree to allow Help Me Grow South Carolina to review my answers and use my information as is consistent with our Privacy Policy and Consent to Use of Data, which is posted on our website: https://helpmegrowsc.org/privacy/.

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.