Rock Island County Regional Office of Education #49
3430 Avenue of the Cities
Moline, Illinois 61265

(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

The Rock Island County All Our Kids Early Childhood Network collaborates with many early childhood programs and services in the community to help them provide high quality programs for children and families, to support your child's development and learning. The AOK Network Coordinator will review your child's information in an effort to support his or her development, including ways to meet any developmental needs. After reviewing your initial screening, the Local AOK Network Coordinator may forward your child’s screening information to the appropriate service provider in partnership with the following agencies: Rock Island County Regional Office of Education, Black Hawk Area Special Education District, and/or Child and Family Connections #13.  The information you enter into this website is confidential and secure. The AOK Network will not share any information that identifies you, or your child, with any other person, organization, agency or school without your further permission.

As part of this effort, the AOK Network may also analyze the aggregated data of the children participating in this program to help us understand how many children are being screened, the overall developmental needs of children in our community, and what additional supports and services they are eligible to receive and what services are still needed. Your child's identifying information is removed from the data immediately. The AOK Network maintains the strictest confidence with all of your child's information, and shall follow all laws and regulations relating to your and your child's privacy rights.


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. By completing the Questionnaires, I agree to:

1. Share responses about my child’s learning and development with an appropriate service provider.

2. Give permission to the AOK Network to aggregate my responses about my child, and any follow-up activities and share this information with community stakeholders.

The permission you have granted by submitting the completed questionnaires will end within one year from the date of the last online screening completed through this program, unless otherwise revoked in writing to the Local AOK Network Coordinator.

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.