ASQ:SE 36months (33-41months) Ages & Stages Questionnaires®: Social-Emotional. A Parent-Completed, Child-Monitoring System for Social-Emotional Behaviors. By Jane Squires, Diane Bricker, & Elizabeth Twombly. with assistance from Suzanne Yockelson, Maura Schoen Davis, & Younghee Kim.. ASQ Age Calculator. This function calculates a child’s age and indicates the ASQ-3 and ASQ:SE-2 questionnaire intervals. To use, enter the questionnaire administration date, the child’s birth date, and the number of weeks premature. To determine weeks premature, subtract the child’s gestational age when born from 39 weeks (full-term.

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“Give the ASQ-3 questionnaire to parents when their child first enrolls with all of the other paperwork . Making it part of the enrollment process helps ensure parents complete it . For children already en-rolled in the center, give parents the questionnaires the same month every year so they learn to expect it .. Ages & Stages 36 Month Questionnaire Please provide the following information. Use black or blue ink only and print O Child’s last name: Child’s gender: legibly when completing this form. Date ASQ completed: Child’s information Child’s first name: Child’s date of birth: Person filling out questionnaire First name: Street address. City: Country: