How long have you been enrolled in the EFMP? / # of Months or Years / How many family members are enrolled? / # of EFMs /
Where are you assigned? / Click here to enter text. / Where do you live? / Click here to enter text. /
Installation
Do you have any current issues or concerns withthe facilities or the services on the military installations where you work, live or patronize, regardingyour family member’s special needs? / Y/N /
If yes, please give possible solution(s). / Click here to enter text. /
Family Case Management
Have you been contacted by your Family Case Worker at least quarterly: / Y/N /
By phone? / Y/N /
By email? / Y/N /
Are you familiar with the services that EFMP Family Case Workers can provide? / Y/N /
Would you like your Family Case Worker to visit your installation quarterly to be available to meet with you personally? / Y/N /
Are you aware that your Family Case Workercan accompany you to special education meetings? / Y/N /
Have you been contactedabout your enrollment expiration date by your Family Case Worker? / Y/N/NA /
What specific support group (by diagnosis) would best support your family’s needs? / Click here to enter text. /
In what ways can your Family Case Worker be more supportive of your family’s needs?
Click here to enter text. /
DD Form 2792 / Respite Care Reimbursement Programs
Have you recently been chargedby a Tricare-authorized provider to haveyour DD Form 2792 completed? / Y/N /
Would you like information about our DD Form 2792 Reimbursement Program? / Y/N /
Are you familiar with our Respite Care Reimbursement Program? / Y/N /
Are you currently enrolled in our Respite Care Reimbursement Program? / Y/N /
Would you like information about available respite care programs in your community? / Y/N /
Training, Education, & Outreach
What special needs workshop topics would you like to see covered? / Click here to enter text. /
What days are best for you, for workshops & support/networking groups? / Click here to enter text. /
What times are best for you, for workshops & support/networking groups? / Click here to enter text. /
What location(s) are best for you, for workshops & support/networking groups? / Click here to enter text. /
Are you receiving the Henderson Hall monthly EFMP Newsletter? / Y/N /
What kinds of articles/information would you like to see in the newsletter? / Click here to enter text. /
Are you interested in EFMP family events, such as bowling, holiday parties, or pool parties? / Y/N /
If yes, please specify the types of family events in which you would participate. / Click here to enter text. /
Web-based Options Available
Henderson Hall EFMP has a webpage (mccshh.com/EFMP.html), a Facebook page ( and a YouTube channel (MFP Henderson Hall).
Do you find web-based options helpful? / Y/N/NA /
Can you suggest other ways we might make EFMP resources and information more accessible to EFMP families?
Click here to enter text. /
Other Comments
Please share any additional feedback or comments that will let us know where we are succeeding and where we can adjust to better meet your needs.
Click here to enter text. /
Henderson Hall Exceptional Family Member Program (EFMP)
Quarterly Survey/Special Needs Forum
Please complete and email to or mail to MCCS,
Attn: EFMP, c/o Mike Flaherty, P.O. Box 4009, Arlington, VA 22204
EFMP Quarterly Survey/Special Needs ForumUpdated: 4October 2016