AGES & STAGES QUESTIONNAIRES

From their first month to six years old, your child is developing skills that set the foundation for lifelong success. By doing some fun, simple activities together and filling out the Ages & Stages Questionnaires (ASQ), you'll be able to monitor your child’s early development and make sure they're on track.

ASQ makes it easy for you to understand how your child is developing. It identifies their strengths and provides activities to help them as they continue to learn. If your child needs assistance in a particular area, you'll receive information about resources and support that can assist them.

Sign up to complete the ASQ

If you have concerns about your child, or the Questionnaire shows a concern, you will be connected to resources that can address them.

To download the complete Ages & Stages Questionnaire brochure, click here.

HOW TO SIGN UP FOR ASQ

It’s quick, easy and free to gain access to these tools. Here’s how:

  1. Sign up for Ages & Stages Questionnaires by filling out the form below.
  2. We'll mail your first Questionnaire. Or you can complete the questionnaire online.
  3. Complete the Questionnaire with your child and mail it back.
  4. We'll send results right away! You'll also get a FREE BOOK, helpful tips, fun activities and connections to resources.
  5. When it’s time, we’ll send you the next Questionnaire. We’ll keep sending them every few months until your child is 5 1/2.

Already enrolled? Click here to complete the ASQ online.

Have questions? Contact Kimberly Broecker at (502) 292-6159 or Kimberly.Broecker@metrounitedway.org

 

Sign Up to Get Your Ages & Stages Questionnaire!

Please Note...

Unfortunately, due to copyright agreements Metro United Way is limited to distributing this tool to residents of our service area in Kentucky and Southern Indiana. We are sorry, but requests completed by residents of other states will not be processed.

If you live outside the Kentuckiana area and you have concerns about your child's development, try contacting your local school district or your state's early intervention program.

Thank you for your interest! You have taken the first step to ensure your child has a successful future.

Are you a resident of Kentucky or the counties of Floyd, Clark or Harrison in Southern Indiana? YesNo
Due to our licensing agreement, if you're not a resident of Kentucky or Floyd, Clark or Harrison counties in Southern Indiana, your application cannot be processed. If you have concerns about your child, please contact your local school district or Indiana's Early Intervention program, First Steps, at 1-800-941-2450 or https://www.infirststeps.com
Would you like to complete the questionaires on paper or online?
 Online
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Child's Name (First and Last): *
Your Name (First and Last): *
Your Relationship to the Child: *
Child's Sex: *
Child's Date of Birth: *
If child was born three or more weeks prematurely, please give the number of weeks premature:
Phone Number:
Mailing Address: *
City: *
State: *
Zip Code: *
What county do you live in? *
E-Mail Address:
How did you hear about this opportunity?
How do you identify your child's race?
Please indicate your language preference:
 English
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By clicking submit you are agreeing to enroll your child in the Ages & Stages Monitoring program.
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