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Fillable Printable Form DS-63

Fillable Printable Form DS-63

Form DS-63

Form DS-63

The informa tio n provided in this que stionnaire is used to determin e th e "s chool at post" educa tio n allowance rates.
Guidance on reporting is contained in the Department of State Sta nd ardized Regulat io ns (DSSR) Section 072. Th e
completed questionnaire should reflect the educational costs of attending the school at post as they pertain to the
majority of eligible U.S. Government (USG) civilian employees with school age children.
INSTRUCTIONS
Report all costs in the currency used for payment and specify the currency
Do not include discounts given to parents for enrolling more than one child in the same school
Sign and date this report to certify completion in accordance with Chapter 270 of the DSSR
Submit a separate DS-63 rep or t for each schoo l wh er e USG dependents att end
All locations and post s
should attach fee statements, catalogs, calendars, transportation invoices, and
any other documentatio n supporting costs to the signed original of this report.
Department of State posts should submit the signed original of this report directly to the U.S. Department
of State, Office of Allowances:
(a)
(b)
U.S. Department of State
Office of Allowances (A/OPR/ALS)
2401 E Street , NW
Washington, DC 20522-0103
Rm. L-314, SA-1
Copies of this report may be sent in advance via fax or e-mail
Non-Department of State locations that are not under the authority of the U.S. Mission should submit the signed
original of this report to the Department of State, Office of Allowances, through their parent agency's
headquarters.
(c)
DS-63
12-2005
Instruction Page 1 of 1
EDUCATION ALLOWANCE QUESTIONNAIRE
SUBMITTING REPORT:
Fax:
202-261-8707
E-mail:
AllowancesO@state.gov
U.S. Department of State
Type of School:
School Location
Date Current School Year Begins
Date Current School Year Ends
Number of School Days
Language of Instruction
Grades Available in the School's Curriculum:
If K-12 is selected above, check half-day or full-day kindergarten program below.
K (Half-Day Program)
Operated by DoD
Coed
Boys Only
Girls Only
K-12 or
K12345678
910
1112
orK (Full-Day Program)
If the age/grade levels of the school are different than those in the U.S. public school system, attach the
Religious-Affiliated (With Mandatory Religious
Instruction)
Report the following information for the current school year by grade(s).Report all costs in the currency used for payment and specifythe
currency.
Cost of basic tuition. Only include costs for required courses.
Cost of books and supplies required by the school, if not included in basic tuition. Include costs such as book rental fees, but do not
include items that students in U.S. public schools normally pay for (e.g., pencils, paper, and books for summer/supplemental reading).
Cost of transportation between home and school by the most commonly used method, if not included in basic tuition. Attach the provider's
transportation invoices. When privately owned vehicles (POVs) are used for daily school transportation, report the mileage of a one-way
trip between the farthest pick-up point and the school.
Most commonly used method of transportation between home and school (e.g., school bus, POVs).
DS-63
12-2005
Page 1 of 2
8.
1.
6.
7.
9.
Applicable
Grade(s)
Basic Tui t i on
Books
and Supplies
Transport at i on (Mileage
for POVs)
Method of Tr a nsportation Be tween
Home and School
Costs for the Current School Year
Street Address
City
Province/State
Country
2.
3.
4.
5.
Example:
Yen 0 (incl. In tuition)
Yen 315,000
School Bus
K-3
Office of Allowances
EDUCATION ALLOWANCE QUESTIONNAIRE
(mm-dd-yyyy)
(mm-dd-yyyy)
Post
Country
School Name
(Do not use P.O. Boxes)
(Check all that apply)
(If bilingual, specify the language in which the majority of classes are taught)
Include the school calendar
school's age/grade equivalency chart. Attach the school catalog.
Yen 1,922,0000
Date (mm-dd-yyyy)
Telephone
E-Mail
Signature of Approving Officer
Agency
Name
Title
Comments (Provide comments to support any responses that may need further explanation.)
Example:
Description
Location/DestinationApplicable Grade(s)Cost
DS-63
Page 2 of 2
Field Trips
Required Fees
I certify that this report has been completed in accordance with the Department of State Standardized Regulations (DSSR) and that all fee
statements, catalogs, calendars, transportation invoices, and any other documentation supporting costs have been attached.
Name and Title of Approving Officer:
10.
Report the costs in the currency used for payment and specify the currency for each field trip included in basic tuition for the current school year.
Provide a description for each field trip. Include information regarding the location or destination of the field trip.
11.
Itemize and report all other required fees in the currency used for payment and specify the currency (e.g., building fees, registration fees,
matriculation fees, laboratory fees, and/or admission fees, per DSSR 274.12e). Indicate whether the fee is annual or one-time, and if it is
refundable or non-refundable. Do not report fees that are included in basic tuition.
Tokyo, Japan (Local Trip)
5-6
Yen 400
Trip to the Tokyo Science Museum
:
12.
Provide the exchange rate for each currency reported in questions 9, 10, 11.
Date(mm-dd-yyyy)
13.
12Yen 300,000
Example:
Registration Fee
XXXX
Exchange Rate per U.S. Dollar
Type
Applicable
Grade(s)
Cost
AnnualOne-timeRefundable
Non-
Refundable
Exchange Rate per U.S. Dollar
Contact Information
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