INSTRUCTIONS FOR COMPLETING DD FORM 2792-1,
EXCEPTIONAL FAMILY MEMBER
SPECIAL EDUCATION/EARLY INTERVENTION SUMMARY
SPECIAL EDUCATION/EARLY INTERVENTION
The DD Form 2792-1 is completed to identify a
family member with special educational/early
DD Form 2792-1 is completed by the parents and
school or early intervention staff. Only this form should
be provided to school or early intervention staff. Do
not include medical information forms that may be
Items 1 - 7 (Completed by sponsor or spouse).
used for EFMP screening or enrollment.
Item 1.a. Application Status (X one).
Items 1 and 2 are completed by parents. The remainder
Initial Screening/Enrollment - First Exceptional Family
of this form is completed by school or early intervention
Member (EFM) application for the family member
Updated Information - Update to a previous EFM
Item 1.a. Release of information. Sponsor name.
evaluation for the family member noted.
Self-explanatory. Completed by sponsor, spouse, or
student who has reached the age of majority.
Request Disenrollment - Used to disenroll a child when
he/she no longer requires special education or early
Item 1.b. Rank. Enter the sponsor's rank.
intervention services, or when the child no longer
qualifies as a dependent.
Item 1.c. Sponsor SSN. Enter the sponsor's social
Item 1.b. Family Status. Place an "X" in the box if there
are any other family members who have been
Item 1.d. Signature of sponsor, spouse, or student who
identified as EFMs.
has reached the age of majority. Self-explanatory. Sign
and date before providing form to school or early
Items 2.a. - k. All items refer to sponsor.
Item 1.e. Date signed. Self-explanatory.
Item 3. Answer Yes if both spouses are on active duty;
Items 2.a. - e. Child information. Self-explanatory.
otherwise answer No.
Completed by sponsor or spouse.
If Yes, complete Items 3.a. - c.
Items 3.a. - e. EIP/School information. Completed by EIP
Item 4.a. Exceptional family member name. Enter
or school personnel. Mark (X) Yes or No for each item. If
name for the family member for whom this form will be
Yes is marked in Items 3.b. or c., remainder of form must
Item 4.b. Relationship to sponsor. (Son, daughter,
Items 4.a. - b. Eligibility criteria. Mark only one. (Codes
in 4.a. are for Army coding only.)
Item 4.c. Date of birth. Self-explanatory.
Item 4.c. Identify the disability, if known. (For example,
blindness, autism, PDD.)
Item 5. Self-explanatory.
Item 5. Severity. Mark only one.
Item 6. Is family member enrolled in DEERS? Military
Item 6. Provider/school official information.
DD FORM 2792-1, NOV 2006
PREVIOUS EDITION IS OBSOLETE.
Page 1 of 3 Pages
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