Important Highlights for the Completion of DD Form 2792-1

“Special Education/EarlyIntervention Summary”

NAVAL MEDICAL CENTER PORTSMOUTHEFMP OFFICE

• DD Form 2792 must be completed for all EFMP enrollees.• DD Form 2792-1 is required if child is:

• 3 – 18 years of age• 19 – 21 if still enrolled in school systems (typically a special needs student)• < 3 if eligible for Early Intervention services

For EFM’s birth to age three, please check “YES” or “NO” in section 5. If the EFM’s age is up to age three and no early intervention services are received and the child does not have an Individualized Family Services Plan (IFSP) OR if your EFM is homeschooled, then only Page 2 will need to be completed and signed by the sponsor or spouse.

DD Form 2792-1Page 2

Family completes this page

For all other school-aged EFM’s, the sponsor (or spouse) will need to complete Page 2, sign the bottom of Page 2, AND the EFM’s school official will need to complete and sign Page 3.

DD Form 2792-1Page 2

EFMP Coordinator complete this section

Family completes this page

The sponsor or spouse must sign and date here to authorize the release of the EFM’s information.

Upon completion of Page 3, the school official must complete all of section 8 and sign and date the bottom of Page 3. If child has an Individualized Education Plan (IEP), Individualized Family Support Plan (IFSP), or other type of education care plan it must be included in the package.

DD Form 2792-1Page 3 Family

completes this section

School or Early

Intervention complete this

section

Additional Information

• If school annotates that there is a 504, Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP) it must be submitted along with the DD 2792-1.

• If unsure, ask the parents if the child has 504, IEP, or IFSP.

Contact Information

• Additional Information can be obtained by contacting your local EFMP Coordinator

Installation EFMP Coordinator Family Support LiaisonNaval Medical Center Portsmouth 757-953-2935 757-953-7805

757-953-8761757-953-8895

JEB Little Creek/Fort Story 757-953-8274 757-462-7563NAS Oceana 757-953-3778 757-433-2912Dam Neck Annex 757-953-9902 Contact Oceana LiaisonNorthwest Annex 757-953-6283 Contact Portsmouth LiaisonYorktown/NNSY 757-953-8415 757-887-4606ARMY 757-314-7923 757-878-1954Air Force 757-225-5950 757-764-3990Marine Corps 757-953-2270Coast Guard 757-686-4025

757-444-2102

Hampton Roads EFMP Point of Contacts

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