Brookes ASQ

Center for Community ILP
907-966-4231
gtrujillo@cfc.org
700 Katlian St
Suite B
Sitka, Alaska 99835
cfc.org

Welcome to the Ages and Stages Questionnaires. Completing the questionnaire designed for your child's age will give you information about his or her development. The questionnnaire will let you know if your child is doing all of the tasks that other children their age may be accomplishing.

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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!

Child Date of Birth
Format: 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)

Screening Date I am screening my child today (2019-02-20) I screened my child and am entering in the responses to a previous screening

I give consent for the Early Learning Program to screen my child named above. I understand that if my child shows a questionable screening r4esult, that I may be offered a child developmental evaluation.

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.

ASQ :: Ages & Stages Questionnaires