18 Month ASQSE - University of Oregon

18 Month ASQ:SE Questionnaire (For children ages 15 through 20 months) Please provide the following information. Child’s name: Child’s date of birth: Today’s date: Person filling out this questionnaire: What is your relationship to the child? Your telephone: Your mailing address:

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Ages & Stages Questionnaires 36 Month Questionnaire

Date ASQ completed: Relationship to child: Parent Street address: Names of people assisting in questionnaire completion: Grandparent or other relative Guardian Foster parent Teacher Child care provider Other: Ages & Stages Questionnaires® Month Questionnaire 34 months 16 days through 38 months 30 days Please provide the following information.

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Ages & Stages Questionnaires 9 Month Questionnaire

Date ASQ completed: Relationship to baby: Parent Street address: Names of people assisting in questionnaire completion: Grandparent or other relative Guardian Foster parent Teacher Child care provider Other: Ages & Stages Questionnaires® Month Questionnaire 9 months 0 days through 9 months 30 days Please provide the following information.

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Ages & Stages Questionnaires 18 Month Questionnaire

18Month ASQ-3 Information Summary 17 months 0 days through 18 months 30 days Communication Gross Motor Fine Motor Problem Solving Personal-Social 123456 2. TRANSFER OVERALL RESPONSES: Bolded uppercase responses require follow-up. See ASQ-3 User’s Guide,Chapter 6. 1. SCORE AND TRANSFER TOTALS TO CHART BELOW: See ASQ-3 …

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6 Month ASQ:SE Questionnaire - University of Oregon

score (see pages 39 and 41 of The ASQ:SE User’s Guide). 2. Review any parent comments.If there are no comments, go to Step 3.If a parent has written in a response, see the section titl ed “Parent Comments” on pages 39, 41, and 42 ofThe ASQ:SE User’s Guideto determine if the response indicates a behavior that may be of concern. 3.

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12 Month ASQ:SE - University of Oregon

18. Does your baby get constipated or have diarrhea? 19. Does your baby let you know when she is hungry, hurt, or tired? 20. When you talk to your baby, does he turn his X head, look, or smile? 21. Does your baby try to hurt other children, adults, or animals (for example, by kicking or biting)? 22. Has anyone expressed concerns about your

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Child’s information Luke K Jones SAMPLE

Month Questionnaire 2 Check the box that best describes your child’s behavior. Also, check the circle if the behavior is a concern. OfTEN OR AlwAyS SOME-TIMES RAREly OR NEvER ChECk If ThIS IS A CONCERN 18. Does your child follow simple directions? For example, does she sit down when asked? ☐ z ☐ v ☐ x v _____ 19.

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Zero Acceptance Number Sampling Plans

For information, please contact ASQ Quality Press at 800-248-1946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 53201-3005. To place orders or to request a free copy of the ASQ Quality Press Publications Catalog, including …

Ages & Stages Questionnaires

About This CD-ROM This CD-ROM contains 1) your End User License Agreement, 2) printable ASQ-3 PDFs, 3) infor-mation about ASQ, 4) information about the authors, 5) training information, and 6) order forms.