KS Order Form 2026.pdf
Kansas Statewide ASQ® System
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Ages & Stages Questionnaires®, Third Edition (ASQ®-3) and Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ®:SE-2)
ORDER FORM – For product information, sample questionnaires and other support resources, visit http://agesandstages.com/ks/. Prices Valid through June 30, 2027
CORE RESOURCES
| Stock # | Product Name | Unit Cost | Qty | Ext Price |
|---|---|---|---|---|
| 70410 | ASQ-3 English Starter Kit | $265.00 | ||
| 70038 | ASQ-3 Spanish Questionnaires | $216.00 | ||
| 72469 | ASQ-3 Learning Activities | $44.96 | ||
| 72476 | ASQ-3 Learning Activities in Spanish | $44.96 | ||
| 79611 | ASQ:SE-2 English Starter Kit | $265.00 | ||
| 79574 | ASQ:SE-2 Spanish Questionnaires | $216.00 | ||
| 69780 | ASQ:SE-2 Learning Activities & More | $44.96 | ||
| 52735 | ASQ:SE-2 Learning Activities & More in Spanish | $44.96 |
OPTIONAL ADDITIONAL RESOURCES
| Stock # | Product Name | Unit Cost | Qty | Ext Price |
|---|---|---|---|---|
| 52650 | ASQ-3 Vietnamese Questionnaires | $157.50 | ||
| 55095 | ASQ:SE-2 Vietnamese Questionnaires | $157.50 | ||
| 52643 | ASQ-3 Arabic Questionnaires | $157.50 | ||
| 53640 | ASQ:SE-2 Arabic Questionnaires | $157.50 | ||
| 53367 | ASQ-3 Chinese Questionnaires | $157.50 | ||
| 55101 | ASQ:SE-2 Chinese Questionnaires (available in Fall 2026) | $157.50 | ||
| SUBTOTAL | ||||
| Shipping at 10% of subtotal | ||||
| TOTAL |
Reference list code KSASQ2026 to receive the discounted pricing and shipping shown above.
SHIP TO INFORMATION:
Name____ Organization ____
Address ____City____State Zip
Credit Card Number ____
Email ____
Purchase Order # __________________________(must include/attach a copy of the P.O.)
Tel ____
- Toll Free: 800-638-3775 (Customer Service) (credit card orders only)
- Email: [email protected] (purchase orders only)
- Fax: 410-337-8539 (credit cards or purchase orders)