The above listed (number) family members will NOT accompany me at the gaining location.
Sponsor's Signature
SECTION III - FAMILY MEMBERS REQUESTING COMMAND SPONSORSHIP TO TRAVEL
INSTRUCTIONS
Sponsors are required to list all family members requesting command sponsorship for the purpose of accompanying the military sponsor in the projected duty location. Page 3 of this form must be completed in its entirety for each family member listed to avoid delays in travel recommendation processing.
Additionally:
A.ALL sponsors with school-aged children, including those who are home-schooled, and those enrolled in Early Intervention who intend to travel OCONUS must complete DD Form 2792-1, Family Member Special Education/Early Intervention Summary. Attach copies of Individualized Education Plan (IEP) and/or Individualized Family Service Plan (IFSP), where applicable.
B.Sponsors must submit completed DD Form 2792, Family Member Medical Summary with Addendum 1, Asthma/Reactive Airway Disease Summary, Addendum 2, Mental Health Summary Addendum 3, Autism, for each family member with a special medical need who is requesting travel. If no special need is known for a family member, sponsor must check "None". OCONUS locations may require the use of these forms for travel considerations for ALL family members requesting OCONUS travel.
C.Sponsors must complete AF Form 1466D, Dental Health Summary,for all EFMP family members over the age of 2 traveling to any location and all members over the age of two traveling OCONUS. OCONUS locations may require the use of these forms for travel considerations for ALL family members requesting OCONUS travel.
D.Definitions:
1.Medical - Potentially life-threatening conditions and/or chronic medical/physical conditions within the last five years, requiring follow-up support more than once a year, or specialty care.
Emotional/Behavioral - Any of the following: current or chronic mental health conditions; inpatient or intensive outpatient mental health services within the last 5 years; greater than one visit monthly for more than 6 months required at the present time. This includes medical care from any mental health provider, a primary care manager, other health care provider, or legal social service involvement.
2.Dental - Care beyond routine annual dental exam or cleaning.
3.Educational - Any child using or intending to use special education services, including any child with an IEP or an IFSP, or a child (aged birth - 3 years) with a high probability of having a developmental delay.
4.Early Intervention or Related Services - Occupational Therapy, Physical Therapy, Speech Therapy, Mental Health, Audiological, or other related services recommended on an IEP or IFSP for the support of appropriate education, as would be covered by State Part B or Part C Services under IDEA. Mark if ever received.
5.Modified Housing/Environmental modifications - Special housing requirements for documented needs, such as wheelchair accessibility.
6.None - No known medical conditions AND no specialized educational services needed. Requires only annual/semi-annual routine visits to primary care manager.
E.Location of medical records: For each family member listed in Section IV, indicate the location of stored medical records. Check "Copies Provided" if the sponsor and/or family member has provided copies of medical records not normally available through the MTF to support consideration of travel.
F.Month and Year of projected travel to Projected Location: Submit dates of travel of family members if different than travel date of sponsor shown in Section 1.G. above.