Throughout this questionnaire, we will ask you to recall information about this child's experiences in
different areas of development. We understand that you may not be able to recall exact times or dates.
Please fill out the questions to the best of your ability or knowledge. The examples provided in this
questionnaire are to be used as guides and are not considered complete lists. All questions are
optional.
The Human Early Learning
Partnership
recognizes and respects diversity within families including cultural background, lifestyle, values, and
child-rearing practices. This questionnaire aims to reflect this diversity.