Reina Ortiz

Partnership for Maternal and Child Health of Northern New Jersey 

50 Union Ave., Ste. 403 

Irvington, NJ  07111 

Direct: 862-359-0520

Cell:   973-856-0575

Email: [email protected] 

Dear Parent/Caregiver,

 

Congratulations on taking steps to get a better understanding about your child’s growth and development.

We are excited about your interest in The Ages & Stages Questionnaire: Social-Emotional Second Edition, (ASQ:SE-2), online screening tool for families living in Camden County. 

To better understand how your child is tracking (progressing/ developing) Socially and Emotionally, this screening tool is provided for use at 2, 6, 12, 18, 30, 36, 48 or 60 months of age.

The questionnaire includes questions about your child’s ability to calm down, take direction, follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings and interact with others.

Within a few days after we receive your completed ASQ-3, we will contact you to share the results and offer follow-up activities and resources.

 

To use this online screening tool, begin by entering your information below and clicking “submit”. If your child was born premature, please enter the number of weeks premature.

*Please note that the information you enter in 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:SE-2!

 

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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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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:SE-2!



(put "0" if not premature)



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.