Along with the forms below, please bring a copy of your child's birth certificate and immunization records to their screening appointment. Forms to be completed for Screenings: 1. Screening Consent form 2. Release of Information form 3. Health History form 4. Hearing and Vision Worksheet
5. Screening Enrollment Form
6. ISD #181 Enrollment Form 7. MN Language Survey 8. Ethnic & Racial Demographic Designation Form 9. ASQ:SE-2 Parent Information for completing the ASQ:SE-2 Please choose the ASQ form below appropriate for your child's age on their screening day: ASQ:SE-2 for 2 yrs, 9 mo-3 yrs, 5 mo
ASQ:SE-2 for 3 yrs, 6 mo-4 yrs, 5 mo
ASQ:SE-2 for 4 yrs, 6 mos- 5 yrs, 5 mo
All forms can be emailed to: [email protected]