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 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. By completing this questionnaire, I understand that the Folsom Cordova Unified School District (FCUSD) and Help Me Grow staff will have access to the information I submit in the questionnaire. Staff will keep my personal information confidential and will not share it without my consent. I agree to have FCUSD staff contact me to ensure that any questions or concerns I have are met. Help Me Grow is operated by the Sacramento County Office of Education in partnership with WarmLine Family Resource Center. 

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.