www.d41.com

Dear Parent/Guardian:

Thank you for contacting us about the School District 41 Pre-Kindergarten Program and Ages & Stages Questionnaire (ASQ). If you would like to be considered for this program and/or participate in a developmental screening, please complete this online questionaire.

Ages & Stages Questionnaire (ASQ-3): This is an at-home assessment to be completed by the primary caregiver. This survey is matched to your child’s current age range and is the initial screening of your child’s development. It will take approximately 60 minutes to complete. You will answer each question “yes,”, “sometimes”, or “not yet”, based on what your child is able to do now. To answer each question, you will do fun and simple activities with your child.

If you have any questions about this process or would like assistance completing the questionnaire, please contact our office at (630) 534-7466.

Regards,

Carrie Jodelka

Preschool Parent Teacher Coordinator

Glen Ellyn School District 41

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, Third Edition (ASQ-3), to help you keep track of your child's development. The questionnaire may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

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-3!

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (12-21-2024) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

By clicking the "Submit" button, you are giving District 41 consent to conduct all preschool screening activities and to provide the results by email.

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.