MCCS 29 Palms

EFMP Forms

EFMP Application Forms

The office staff can provide enrollment forms, offer help in the preparation of the forms, review completed forms for accuracy and forward the enrollment package to Headquarters Marine Corps.

DD 2792 Instruction Application (pdf)

Form should be completed by the doctor or specialist that is currently treating the EFM. A doctor's appointment should be scheduled and the EFM should drop off the 2792 Application at this time. Page 1 of 8 should be signed prior to the doctor visit to give the doctor authorization to complete paperwork. The doctor will complete the form within a few weeks and the EFMP Case Manager will pick up the paperwork from the hospital, or for out of the area doctors can return the form by fax 760.830.8997.

DD 2792-1 Special Education/ Early Intervention Form (pdf)

Page two and the top of page three of this form can be completed by the parent. Bring this form to the EFMP office and we will complete the process. Once all paperwork is complete it will be submitted to Headquarters Marine Corps for a category. This process can take a few weeks, and a letter will be sent to the family indicating their category.

Waiver for Services (pdf)

By signing this form you allow the EFM Program access to the information in the Exceptional Family Member Medical Summary. This allows the EFMP office to better serve the enrolled member, because we can identify beneficial resources and/or benefits. We inform families of educational workshops, town halls, assist in advocating for the EFM, or contact the family to offer further assistance.

Declination of Services (pdf)

By signing this form the EFMP staff will not contact the EFM family. The signing of either form is not permanent and can be withdrawn in writing or by contacting the EFMP Office. The service member cannot sign a waiver for the spouse or an adult dependent, 18 years or older. The adult EFM must complete their waiver. A minor's waiver has to be signed by a parent or guardian. Once the form has been signed please bring it to the EFMP office for submission to Headquarters Marine Corps. We must have one of the two waivers on file before the case can proceed.

Authorization to Release and Consent to Exchange Information, Navmc 11720 (pdf)