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Early Intervention / Early Childhood Special Education
503-675-4000
13455 SE 97th Ave
Clackamas, Oregon 97015
www.clackesd.org



(put "0" if not premature)

Screening Date Options

For ASQ-3™ English

Screening Date Selection


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.

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