Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

Project ABC and EEC collect ASQ® screening data to identify trends and patterns in the early education and care settings in order to better support the programs with resources and professional development opportunities. EEC is only analyzing the combined scores of all the screening results. The specific names of children are not included in the analysis. ASQ® results are confidential. Both Project ABC and EEC follow the Massachusetts confidentiality laws to ensure that your and your child’s personally identifiable information is protected. EEC signed a data-sharing agreement with United Way to jointly develop a data platform to analyze the combined data. The data-sharing agreement ensures that all individuals accessing the data will maintain confidentiality and ensure your and your child’s privacy. If you do not wish to have your child’s information entered into the online database, you may decline this option. Your child may be screened using the ASQ® paper version of the questionnaire, and no information will be shared.

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.

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.