November 11, 2002
Dear _____________________________
I am a student at Iowa State University preparing to work with young children and families. This
semester I am enrolled in a course on Assessment and Curriculum: Ages Birth through 2 Years,
where one of my assignments requires me to work with a parent to observe and describe one
child’s development. In order to guide our observation, I will be using the Ages and States
Questionnaire. The questionnaire should take approximately 30 minutes to complete, and
involves activities that would typically occur during your daily interactions with your child. I
will ask you questions about some things your child can and cannot do. As a student, I will
summarize this observation, which I will submit to my instructor, Dr. Susan Hegland, 4380
Palmer, Department of Human Development & Family Studies, Iowa State University, Ames, IA
50011-4380. All information about your baby and your family will be kept confidential. If you
have questions about the assignment, you may contact her at (515) 294-4616, or
shegland@iastate.edu.
I am learning to use this questionnaire because, as a professional, I will be working with parents
to follow their children’s growth and development. The first five years of life are very important
to your child. This time sets the stage for success in school and later life. During infancy and
early childhood, many experiences should be gained and many skills learned. It is important to
ensure that each child’s development is proceeding without problem during this period. As a
professional, I will be working with parents to help decide whether their baby’s development is
typical. However, as a student, I am not yet qualified to make such a recommendation.
If, after my observation, you have concerns about your child’s development, you may wish to
contact your baby’s doctor or another agency to conduct a further examination.
If you agree to allow me to complete this questionnaire with you and your baby, please complete
the portions below. Thank you for your assistance with this assignment.
Sincerely,
_________________________________
I have read the description of the observation assignment, and I wish to participate. I am willing
to be present and to work with _____________(student’s name) to fill out a questionnaire about
my child’s development. I understand that all information about my child and my family will be
kept confidential.
Parent’s or guardian’s signature
________________________________
Date:
_________________________
Child’s name:
_________________________
Child’s birthdate:
_________________________