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

I give Washtenaw Intermediate School District permission to read my child’s screening results and contact me regarding any future supports or resources that would be helpful to giving my child a great start. I also give permission to use my child’s score results in a compiled list to show county data results. The compiled list would not identify my child using their name, address, or other specific identifying information.

The Ages and Stages Questionnaires are being offered by Washtenaw Intermediate School District to Washtenaw County residents. Please note that questionnaires completed by residents of other counties will be discarded and will not be scored.

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.