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YOU MUST PRINT A CONFIRMATION RECEIPT WHEN YOU COMPLETE AN ASQ. THESE CANNOT BE PRINTED LATER.

2. THE COMPLETION OF ASQs IS A LEGAL AND CONTRACTUAL REQUIREMENT. PLEASE BE SURE YOU COMPLETE ALL ASQs BY THE DUE DATE required by law, as specified in the invitation letter above. While ELCAC Best Practice advice is to complete ASQs within the first 45 days of the child's enrollment and at redetermination.

3. Read everything carefully before completing the ASQ-3. Direct all questions to Sarah White, Child Development & Inclusion Coordinator; [email protected]; 352-375-4110, ext. 121.

ENTER THE CHILD'S LEGAL NAME, AS SPELLED ON THE CERTIFICATE OF ELIGIBILITY, INCLUDING ANY APOSTROPHES (') AND HYPHENS (-)

Child Date of Birth
Format: yyyy-mm-dd

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (2024-04-29) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

By clicking on the "SUBMIT" button, the provider agrees to share all results with the child's parent or legal guardian within 30 days after ELCAC returns the results via secure email.

Florida Rule 6M-4.720 and all applicable statutes require ASQs for all children ages 2 weeks to kindergarten entrance who receive School Readiness funding at the time of new enrollment and at the time of redetermination.

All parents receiving School Readiness funding have previously signed Screening and Assessment consent during the School Readiness eligibility process. If there is an exception to this, you will be informed in writing of the children who should not be screened. If any parent has a question or concern about our screening process, please ask them to contact Sarah White at ELCAC for technical assistance. Thank you.

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.