DS-574 Information Regarding Professional Staff Members of Over

U.S. Department of State

INFORMATION REGARDING PROFESSIONAL STAFF
MEMBERS OF OVERSEAS SCHOOLS
Name of School

OMB APPROVAL NUMBER XXXX-XXXX
EXPIRATION DATE XX/XX/XXXX
*ESTIMATED BURDEN: 25 MINUTES

School Year
To
Date (mm-dd-yyyy)

Date (mm-dd-yyyy)

INSTRUCTIONS
On pages 2 and 3 of this form provide the information requested concerning each professional staff member. In
column 1 on page 2, identify each professional staff member by the appropriate letter according to the categories listed
below. All staff members in the same letter category should be grouped together and listed by alphabetical order of
surname. Use additional copies to this form if it is not possible to list all staff member on one form. Submit to the
Department in original and one copy by December 15.
CATEGORIES OF STAFF
(Insert appropriate letter in column 1 of page 2 beside the name of each professional staff member.)
a. U.S. citizen recruited specifically for service in the school and residing in the country for the sole purpose of employment
in the school
b. U.S. citizen dependent of a U.S. citizen, U.S. Government employee, including contract employee, residing in
the country primarily as a dependent
c. U.S. citizen dependent of a U.S. citizen who is not employed by the U.S. Government
d. U.S. citizen dependent of a local national
e. U.S. citizen dependent of a third country national
f. Other U.S. citizens
g. Local national who is a dependent of a U.S. citizen
h. Other local national
i. Third-country national who is a dependent of a U.S. citizen

DS-574
XX-XXXX

*Public reporting burden for this collection of information is estimated to average 25 minutes per response, including
time required for searching existing data sources, gathering the necessary data, providing the information required, and
reviewing the final collection. Send comments on the accuracy of this estimate of the burden and recommendations for
reducing it to

Page 1 of 3

CATEGORY
(See instructions)

Name of School

1

NAME
(List administrator(s) first then
alphabetically those in category
a, in category b, and so on.)
2

DS-574
XX-XXXX

NATIONALITY

POSITION OR
TEACHING DUTIES

3

(Indicate grade or subject;
if part-time administrative
and part-time teaching,
include both)
4

HIGHEST DEGREE EARNED

Degree

Year

5

6

INSTITUTION WHICH CONFERRED DEGR
(Include location)
7

Indicate with "X" if teaching in
field of academic preparation

10
Date
Present
Employment
First Began
Terminal
Date of
Contract

(mm-yyyy)
11
(mm-yyyy)
12

DS-574
XX-XXXX
13
14
15
16
18
19
20

Indicate with "X" if Full-time

Percent of Compensation
Covered by U.S.
Government Grant

17

Value of Other Allowances
(Annual Basis)
Identify
(Tuition for dependents,
R and R, use of auto,
club memberships, etc.)
Percent of Compensation
Paid in U.S. Dollars

YEARS OF
EXPERIENCE
Costs of International Travel
and Goods Shipment
(Annual Basis)

Annual
Salary
Value of Housing and Utilities
Provided in Addition to Salary
(Annual Basis)

In Other Educational Position

In Present Type Position
(compute present year as 1)

DATES OF
EMPLOYMENT
AT SCHOOL
COMPENSATION
(Express in terms of U.S. dollars only)

21