Enrollment Form

DD Form 2792 EFMP Enrollment Form

EFMP enrollment is mandatory and required immediately upon identification of a special need.

Please use DD Form 2792, Exceptional Family Member Medical and Educational Summary and DD Form 2792-1, Exceptional Family Member Special Education/Early Intervention Summary to complete this process.

Every Military Treatment Facility (MTF) appoints an EFMP Coordinator to facilitate the enrollment process. Coordinators provide enrollment forms, offer help in the preparation of the forms, review completed forms for accuracy, and forward the enrollment package to the Central Screening Committee (CSC). If you are not located near an MTF, forms may be available from one of the following locations:

Fleet and Family Support Centers (FFSC) Personnel Support Offices
Navy Liaison Offices
Navy Personnel Command (NPC) EFM Program Managers(PERS-451) in Millington, Tenn.

Both medical and educational portions must be completed for school-aged children. The treating physician(s) should complete the medical forms.

An official at your child’s school must complete Addendum B Special Education.

Review the forms before signing. You are responsible for their completeness and accuracy.

Return the completed forms to the MTF. The Coordinator will review and sign the forms and forward them to a CSC.

In areas with no MTF or EFMP Coordinator, you should mail the EFMP application forms (with other required documentation attached) to the appropriate CSC.

CENTRAL SCREENING COMMITTEE (CSC)

Forward completed applications to the appropriate Central Screening Committee. The CSC that will review your application is determined by the location of your current duty station.

CSC locations:

1. East of the Mississippi River in the continental United States, Europe, Africa, South America, and the Caribbean:

Central Screening Committee (Code 60465C)

Exceptional Family Member Program

Naval Medical Center

620 John Paul Jones Circle

Portsmouth, VA 23708-2197

Commercial (757) 953-5900

2. West of the Mississippi River in the continental United States and Alaska:

Department of the Navy

Naval Medical Center, Suite 100

34520 Bob Wilson Drive

San Diego, CA 92134-2100

Commercial (619) 532-6910

3. Countries in the South Pacific, Asia, and Hawaii:

EFM Central Screening Committee

U.S. Naval Hospital Yokosuka

PSC 475, Box 1, Code 121Y

FPO AP 96350-1600

Commercial 011-81-6160-43-5379

DSN: 243-5379