We value your privacy We use cookies to enhance your browsing experience, serve personalised ads or content, and analyse our traffic. By clicking "Accept All", you consent to our use of cookies. CustomiseReject AllAccept All Powered by [Visit CookieYes website](https://www.cookieyes.com/product/cookie-consent/?ref=cypbcyb&utm_source=cookie-banner&utm_medium=fl-branding) Customise Consent Preferences We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below. The cookies that are categorised as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... Show more NecessaryAlways Active Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data. - Cookie rc::a - Duration Never Expires - Description This cookie is set by the Google recaptcha service to identify bots to protect the website against malicious spam attacks. - Cookie wpEmojiSettingsSupports - Duration session - Description WordPress sets this cookie when a user interacts with emojis on a WordPress site. It helps determine if the user's browser can display emojis properly. - Cookie rc::c - Duration session - Description This cookie is set by the Google recaptcha service to identify bots to protect the website against malicious spam attacks. - Cookie VISITOR\_PRIVACY\_METADATA - Duration 6 months - Description YouTube sets this cookie to store the user's cookie consent state for the current domain. - Cookie cookieyes-consent - Duration 1 year - Description CookieYes sets this cookie to remember users' consent preferences so that their preferences are respected on subsequent visits to this site. It does not collect or store any personal information about the site visitors. - Cookie wordpress\_test\_cookie - Duration session - Description WordPress sets this cookie to determine whether cookies are enabled on the users' browsers. Functional Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features. - Cookie VISITOR\_INFO1\_LIVE - Duration 6 months - Description A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface. - Cookie yt-remote-connected-devices - Duration Never Expires - Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. - Cookie ytidb::LAST\_RESULT\_ENTRY\_KEY - Duration Never Expires - Description The cookie ytidb::LAST\_RESULT\_ENTRY\_KEY is used by YouTube to store the last search result entry that was clicked by the user. This information is used to improve the user experience by providing more relevant search results in the future. - Cookie yt-remote-device-id - Duration Never Expires - Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. - Cookie yt-remote-session-name - Duration session - Description The yt-remote-session-name cookie is used by YouTube to store the user's video player preferences using embedded YouTube video. - Cookie yt-remote-fast-check-period - Duration session - Description The yt-remote-fast-check-period cookie is used by YouTube to store the user's video player preferences for embedded YouTube videos. - Cookie yt-remote-session-app - Duration session - Description The yt-remote-session-app cookie is used by YouTube to store user preferences and information about the interface of the embedded YouTube video player. - Cookie yt-remote-cast-available - Duration session - Description The yt-remote-cast-available cookie is used to store the user's preferences regarding whether casting is available on their YouTube video player. - Cookie yt-remote-cast-installed - Duration session - Description The yt-remote-cast-installed cookie is used to store the user's video player preferences using embedded YouTube video. Analytics Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc. - Cookie \_ga - Duration 1 year 1 month 4 days - Description Google Analytics sets this cookie to calculate visitor, session and campaign data and track site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognise unique visitors. - Cookie \_gid - Duration 1 day - Description Google Analytics sets this cookie to store information on how visitors use a website while also creating an analytics report of the website's performance. Some of the collected data includes the number of visitors, their source, and the pages they visit anonymously. - Cookie \_hjSessionUser\_\* - Duration 1 year - Description Hotjar sets this cookie to ensure data from subsequent visits to the same site is attributed to the same user ID, which persists in the Hotjar User ID, which is unique to that site. - Cookie \_hjSession\_\* - Duration 1 hour - Description - Cookie \_ga\_\* - Duration 1 year 1 month 4 days - Description Google Analytics sets this cookie to store and count page views. - Cookie YSC - Duration session - Description YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages. Performance Performance cookies are used to understand and analyse the key performance indexes of the website which helps in delivering a better user experience for the visitors. - Cookie \_gat - Duration 1 minute - Description Google Universal Analytics sets this cookie to restrain request rate and thus limit data collection on high-traffic sites. Advertisement Advertisement cookies are used to provide visitors with customised advertisements based on the pages you visited previously and to analyse the effectiveness of the ad campaigns. - Cookie \_\_Secure-YEC - Duration past - Description YouTube sets this cookie to stores the user's video player preferences using embedded YouTube video - Cookie \_\_Secure-YNID - Duration 6 months - Description Google cookie used to protect user security and prevent fraud, especially during the login process. - Cookie \_\_Secure-ROLLOUT\_TOKEN - Duration 6 months - Description YouTube sets this cookie to manage feature rollout and experimentation. It helps Google control which new features or interface changes are shown to users as part of testing and staged rollouts, ensuring consistent experience for a given user during an experiment. Uncategorised Other uncategorised cookies are those that are being analysed and have not been classified into a category as yet. No cookies to display. Reject AllSave My PreferencesAccept All Powered by [Visit CookieYes website](https://www.cookieyes.com/product/cookie-consent/?ref=cypbcyb&utm_source=cookie-banner&utm_medium=sl-branding) # ASQ:SE-2 Special Release Extension Request Form Please fill out the following form to request an extension on the ASQ:SE-2 Special Release materials. - First Name\* - Last Name\* - Your Title/Position\* - Email\* - Phone\* - I am an authorized user of ASQ®:SE-2 questionnaires and am signing the agreement on behalf of: - Organization Name\* - Organization Address\* Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands - Organization Website/URL\* - My organization has previously purchased ASQ:SE-2 Questionnaires and/or ASQ:SE-2 in Spanish Questionnaires. I understand that I may be contacted to confirm this and provide a valid proof of purchase. - Confirmation\* I confirm that - I represent an organization engaged in direct service provision to children and families. - The organization’s employees work one-on-one with families to implement screening during interactive home visits, parent conferences, and telehealth appointments. - The organization’s employees now need to provide these services virtually or remotely rather than in person. - The organization is responsible for providing employees with guidance on use of the Special Release materials, virtual service delivery, and any relevant privacy considerations. - ASQ®:SE-2 Special Release Permission Agreement The following paragraphs constitute the Permission Agreement (“Agreement”) for the ASQ Special Release. “Materials” refers to alternate format download files for _Ages & Stages Questionnaires®: Social-Emotional, Second Edition: A Parent-Completed Child Monitoring System (ASQ®:SE-2)_ and/or _Ages & Stages Questionnaires®: Social-Emotional in Spanish, Second Edition: A Parent-Completed Child Monitoring System (ASQ®:SE-2 Spanish)_ By accessing or using the Materials, I (“the User”) am accepting the terms and conditions of this Agreement with Paul H. Brookes Publishing Co., Inc. (“Brookes Publishing Co.”). Brookes Publishing Co. authorizes the User to: a) share the Materials with their organization’s employees by email or text to support interactive virtual service provision to children and families; and b) post the Materials for access on a local area network (LAN) or intranet, provided that all employees with access work at the same office as the User. _The Materials may not be posted on the Internet under any circumstances._ Brookes Publishing authorizes the User and employees of the User’s organization to: a) share the Materials in JPEG format (ASQ:SE-2 English and/or ASQ:SE-2 Spanish questionnaire images) directly with individual families by text or email for viewing during interactive web conferences and telephone calls as they implement ASQ:SE-2 screening; and b) use the Materials in fillable PDF (ASQ:SE-2 English and/or ASQ:SE-2 Spanish Information Summary sheets) to record screening responses, results, and follow-up actions during interactive web conferences and telephone calls. Brookes Publishing Co. authorizes the User and employees of the User’s organization to access and use the Materials through June 30, 2024. With the exception of this temporary permission to email and text the Materials, the User and employees of the User’s organization must abide by the ASQ:SE-2 End User License Agreement and Photocopying Release and ASQ:SE-2 Spanish End User License Agreement and Photocopying Release. - Electronic Signature\* By entering your name, you are signing the form electronically and agree it is the legal equivalent of your manual signature on this agreement. By submitting this form you agree to receive email communications from ASQ and Brookes Publishing. - #### What ASQ Users are Saying “I like the ASQ:SE, which is an easy non-threatening tool to use to assess important social-emotional developmental milestones of the baby…. **This tool lends itself well to developing educational activities to foster a healthy parenting relationship**.” Cynthia Suire, MSN, RN, Nurse–Family Partnership Program Louisiana Office of Public Health - [Previous](https://agesandstages.com/asqse2-special-release-extension/#) - [Next](https://agesandstages.com/asqse2-special-release-extension/#) Notifications reCAPTCHA Recaptcha requires verification. [Privacy](https://www.google.com/intl/en/policies/privacy/) \- [Terms](https://www.google.com/intl/en/policies/terms/) protected by **reCAPTCHA** [Privacy](https://www.google.com/intl/en/policies/privacy/) \- [Terms](https://www.google.com/intl/en/policies/terms/)