Enrollment, respite care, and other forms needed for EFMP are included.

If you are having difficulty opening the forms, please email us at efmphh@usmc-mccs.org and we will be more than happy to send you the forms via email. Thank you.

 

Enrollment
  • DD 2792 (Medical Summary) - (PDF 110KB)
  • DD 2792 (Medical Summary) - Fillable - (PDF 110KB)
  • DD 2792-1 (Special Education Summary) - (PDF 70KB)
  • DD 2792-1 (Special Education Summary) - Fillable - (PDF 70KB)
  • DD Form 2792 (Instructions) - (PDF 172KB)
  • DD Form 2792-1 (Instructions) - (PDF 187KB)
 
General
  • Authorization to Release and Consent to Exchange Information (PDF 1.3MB)
  • Family Support Service Declination Form (NAVMC11719) – (PDF 31KB)
  • Henderson Hall EFMP Customer Rights and Responsibilities (PDF 310KB)
  • Henderson Hall EFMP Quarterly Survey/Special Needs Forum
  • Henderson Hall EFMP Standards of Service (PDF 226KB)
  • Incapacitated Adult: Instructions for designating a disabled child (over 21) as a permanent dependent.
  • Notification Of Privacy Limitations (PDF 169KB)
  • PCS Needs Assessment (PDF 221KB)
 
Respite Care Reimbursement Program
  • Henderson Hall EFMP Respite Care Packet (PDF 1.5MB)
  • Respite Care Log (fillable) – (PDF 3.1MB) – Please use Internet Explorer to open this file
  • Hold Harmless Agreement (PDF 175KB)

Contact Information

Exceptional Family Member Program (EFMP)

1555 Southgate Rd.
Bldg. 12
Arlington, VA 22026

Program Manager: 7036936510

Administrative Specialist: 7036937195

Family Case Worker: 7036934172

Family Case Worker: 7036936368

Training, Education & Outreach Specialist: 7036935353

Email: efmphh@usmc-mccs.org

Follow Exceptional Family Member Program (EFMP):

Hours
Sunday Closed
Monday 7:30AM - 4:30PM
Tuesday 7:30AM - 4:30PM
Wednesday 7:30AM - 4:30PM
Thursday 7:30AM - 4:30PM
Friday 7:30AM - 4:30PM
Saturday Closed
 
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