Please enter your full name. * Please enter your child's initials. If participating with twins, please distinguish between them. * What is your child's date of birth? * MM DD YYYY What is your child's gender? * Female Male Nonbinary Transgender Not sure/Prefer not to answer What is your child's race/ethnicity? * Black Asian Hispanic or Latina/o American Indian or Alaskan Native Hawaiian Native or Pacific Islander Middle Eastern or North African White Other Two or more What languages does your child speak? * Where does your child hear and speak English? * Home School Both Parent/caregiver education. * Less than high school Highschool AA Degree 4 years college or above Prefer not to answer Yearly family income. * $0-16,500 $16,501-$24,500 $24,501-$44,500 $44,501-$60,000 $60,001-$80,000 Over $80,000 Not sure/Prefer not to answer Does your child receive special services, such as speech-language therapy, early intervention, physical therapy, occupational therapy, behavioral therapy, etc.? * Yes No Not sure If yes, please describe. 3 year old Basic Speech Screener (BASS) This questionnaire focuses on how a young child makes sounds to form words. It does not assess language or communication skills. Parents/caregivers, teachers and childcare providers who know the child can complete the questionnaire. Complete this questionnaire with your child present and have them say each sound. (No answer required in space below). Can you understand what your child says? * Often or Always Sometimes Rarely or Never Can other people understand what your child says? * Often or Always Sometimes Rarely or Never Do you have any concerns about your child's speech? * Often or Always Sometimes Rarely or Never If yes, please describe. This section assesses how your child says sounds at the beginning, middle and end of words. Have your child say words with each of the following sounds in all three positions. The listed words are examples. (No answer required in space below). b as in book * Yes Not Yet b as in baby (b in the middle of a word) * Yes Not Yet b as in crab (b at the end of a word) * Yes Not Yet p as in pig * Yes Not Yet p as in puppy (p in middle of a word) * Yes Not Yet p as in pop (p at the end of a word) * Yes Not Yet m as in mouse * Yes Not Yet m as in tummy * Yes Not Yet m as in home * Yes Not Yet n as in nose * Yes Not Yet n as in bunny * Yes Not Yet n as in moon * Yes Not Yet w as in water * Yes Not Yet w as in flower * Yes Not Yet w as in wow (w at the end of a word) * Yes Not Yet d as in dog * Yes Not Yet d as in spider * Yes Not Yet d as in bed * Yes Not Yet t as in toe * Yes Not Yet t as in potato * Yes Not Yet t as in cat * Yes Not Yet g as in game * Yes Not Yet g as in tiger * Yes Not Yet g as in dog * Yes Not Yet k as in cake (k at the beginning of a word) * Yes Not Yet k as in cookie (k in the middle of a word) * Yes Not Yet k as in duck * Yes Not Yet v as in vegetable * Yes Not Yet v as in movie * Yes Not Yet v as in love * Yes Not Yet f as in finger * Yes Not Yet f as in muffin * Yes Not Yet f as in leaf * Yes Not Yet This section assesses how your child says sounds in different word positions, as well as different combinations of sounds in words. (No answer required in space below). Does your child say sounds at the beginning of words, as in soap or jacket? (Mark Not yet if child says oap for soap or acket for jacket.) * Yes Not Yet Does your child say sounds at the end of words, as in booK, caT, or piG? (Mark Yes if child usually says sounds at the end of words, mark Not yet if they don’t.) * Yes Not Yet Does your child say /ng/ in the middle of words, as in finger? * Yes Not Yet Does your child say /h/ at the beginning and middle of words, as in house and behind? * Yes Not Yet Does your child say /y/ at the beginning of words, as in you? * Yes Not Yet Comments: Thank you!