ASQ Train the Trainer Application
Healthy Child Care Texas (HCCT) is hosting a seminar by Brooks Publishing on the Ages and Stages Questionnaire (ASQ 3/ASQ:SE2). This FREE Train-the-Trainer seminar will be held on October 28-30th at the University of Houston in Clear Lake, Houston, Texas.

This training will cover the ASQ-3 and ASQ:SE-2 for children ages 0-6, which are universal developmental and social-emotional screening tools used to identify children at risk for a developmental delay. This seminar can accommodate up to 25 persons and will certify participants to provide ASQ 3/ASQ:SE2 training and support to their agency providers and partnering providers. For more information, please visit https://agesandstages.com.

Participants must have a bachelor’s degree in early childhood education or related field.
If interested in the training please submit an application by Friday, September 27th.
First and Last Name *
Your answer
Email Address *
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Phone Number *
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Place of Employment *
Your answer
Please select your highest degree of education in an Early Education Field or related field. Please provide a copy of your transcript for verification. *
Have you had previous training on the use of the Ages & Stages questionnaires? *
Are you an Independent Trainer? *
Are you a Child Care Health Consultant? *
If so, when did you complete the CCHC training? *
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Are you listed on the Texas Trainer Registry? *
If so, provide your Trainer ID and Trainer Registry Renewal Date. *
Your answer
List the areas in Texas you can offer training to child care providers. *
Your answer
How many trainings did you facilitate for child care providers last year? *
Your answer
Describe the early childhood services offered by your agency or independent services you offer. *
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Describe your current position with your agency or private work: *
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Explain how you thing the ASQ training and implementation is beneficial for your agency or private work. *
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Share resources and collaborations in your area available when a referral is made for a child with special needs. *
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If applicable, please confirm that you have approval and support from your agency's Executive Director to attend the ASQ training and implementation of the ASQ Questionnaires in you community. *
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