FOCUS, Inc.
907-694-6002
scriley@focusoutreach.org
11901 Business Blvd., Ste. 209
Eagle River, Alaska 99577
www.focusoutreach.org

Welcome to the FOCUS ASQ-3 online screening program! We are exciting to offer this convenient way for you to screen your child. The information you supply will help reveal your child's strengths, uncover any areas of concern, and determine if there are community resources or services that may be useful for your child or family.

If it is possible, please print out the questionnaire and set aside a time to try each of the activites with your child. Then go back online and fill out the form.  This gives your child the best opportunity to do well in the screening. Please mark Yes if your child is performing the skill, Sometimes if your child can perform the skill but not consistently, and Not Yet if your child is not performing the skill at all.

Section 2 asks important questions about your child's development and is your time to voice any concerns you may have with your child.  

Finally, have fun completing the questionnaire with your child, and make sure he or she is rested, fed, and ready to play before you try the activities. Please complete it within one week to guarantee accurate age equivalancy.

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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!



(put "0" if not premature)

We are committed to your privacy and the privacy of your child. Any information you submit in the ASQ online system can only be viewed by our staff who have authorized access to your account. All information collected will be treated as confidential and will only be shared with your written consent.

The State of Alaska EI/ILP has provided funding for this project to provide access to developmental screening for all families. The State EI/ILP staff will be tracking the number of children who are screened but will not be able to view any identifying information. All information collected is procted under the Family Education Rights and Privacy Act (FERPA) and Health Insurance Protability and Accountability Act (HIPPA).

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.