Ds 5520 Supplemental Questionnaire To Determine Identity For Us Passport Page 3
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3Section D: Schools
Please list all schools that you attended inside and outside of the United States (or as many as possible)
City
Name of School
State
Country
Dates of Attendance
Example
Example
Example
Example
Example
Washington Elementary
Anytown
USA
08-1990 to 06-1994
Anystate
Section E: Residences
Please list your five most recent permanent residences (or as many as possible)
Temporary residences of less than 90 days may be omitted
Time of
Street
City
State
Zip Code
Country
Residence
Example
Example
Example
Example
Example
Example
03-1990 to
123 First St.
Anytown
Anystate
11011
USA
06-2002
Section F: Signature
I declare under penalty of perjury that all responses contained in this document are true and correct to the best of my
knowledge.
Signature
Date
Page 3 of 3
DS-5520 06-2013
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