Dear Parent/Caregiver:

Would you please take a few minutes to evaluate our questionnaires? We appreciate your participation in our program and hope that our services have been helpful to you.

Please circle the number that best expresses your opinion.

1. Approximately how many minutes did it take you to fill out each questionnaire?  
   ______ minutes.

Did you consider this amount of time:  
very little time                 too much time  
      1    2    3    4

Comments:

2. Did the questionnaires help you think about your child’s behavior?  
very little                   very much  
      1    2    3    4

Comments:

3. After filling out the questionnaires, did you learn any new things about your child?  
very few                   very many  
      1    2    3     4

Comments:

4. Were any items unclear or difficult to understand?  
very few                   very many  
      1    2    3    4

Comments:

5. Did you enjoy participating in this program?  
very little                   very much  
      1    2    3    4

Comments:

If you have any further comments about the questionnaires, please write them below.

*Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™), Squires, Bricker & Twombly.* © 2015 Paul H. Brookes Publishing Co., Inc. All rights reserved. Ages & Stages Questionnaires® is a registered trademark and ASQ:SE-2™ is a trademark of Paul H. Brookes Publishing Co., Inc.