Birth to Three Early Intervention Program
Hope Sanson, Part C Data Manager
410 Federal Street
Dover, Delaware 19901

(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

As part of consenting to do the ASQ screenings, I understand that screening information entered online will be shared with the Delaware Department of Education, Office of Early Learning, the Delaware Department of Public Health and Delaware Health and Social Services to determine overall developmental trends that will help with budget and resource decisions. Screening results will also be shared with your childcare provider or preschool provider, because they must keep track of completed developmental screenings. If there is a concern, you will be contacted with your results of a recommendation of a referral to Child Development Watch. 

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.