Screening Forms

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 Screening:
Screening Consent form

Release of Information form

Health History form

Screening Enrollment Form

ISD #181 Enrollment Form

MN Language Survey

Ethnic & Racial Demographic Designation Form

Hearing & Vision Screening Worksheet

Please choose the ASQ form below appropriate for your child's age on their screening day:
ASQ for 2 yrs, 9 mo-3 yrs, 5 mo

ASQ for 3 yrs, 6 mo-4 yrs, 5 mo

ASQ for 4 yrs, 6 mos- 5 yrs, 5 mo

Forms can be emailed to:

Website by SchoolMessenger Presence. © 2020 Intrado Corporation. All rights reserved.