Glenbard Early Childhood Collaborative Caregivers

Caregiver Screening Survey

Who: Hey parents and caregivers! We value your input regarding developmental screenings.
What: A developmental screening is a checklist that asks questions about your child’s development. You might have received this from a doctor, pre-school, or other places in your community.
When: Screenings can occur anytime from birth to age five.
Why: Your answers will help support children and families in healthy growth and development throughout our community.

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* 1. What Zip Code do you live in:

60139

60137

60148

Other (please specify)

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* 2. I identify my ethnicity as (select all that apply below):

Hispanic/Latinx

Native American/ Alaskan Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Other (please specify)

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* 3. What do you know about developmental screenings?

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* 4. Why do you think some children are not being screened?

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* 5. Has your child received a Developmental Screening?

Yes

Not sure