Madeira School I-20 Application Form

* = required field

Surname/Primary Name *
Name on passport *
Preferred Name *
Date of Birth *
Foreign address that will appear on I-20 *

Guardian Information

All international students, as well as those domestic boarders who live a significant distance away (3+ hours), are required to have a local guardian (an adult relative or friend of the immediate family) who lives within two hours of Madeira.

The guardian is agreeing to take the student off campus and assume responsibility for her care if the student is ill and cannot be served by The Madeira School’s Health Center, if the School is closed for an emergency, or if the School deems it inappropriate for the student to remain on campus due to disciplinary reasons.

The family’s identification of a guardian constitutes authorization and consent to the School’s placing the student in the care of the guardian whenever the School, in its discretion, determines the student’s health or emergency conditions make it appropriate to do so. If the primary guardian is unavailable or unwilling to take responsibility for the student when a student must leave campus, the family is responsible for informing the school and for securing a suitable replacement.

**To have your I-20 issued and to be eligible to begin classes in September, students who live outside the US must have a guardian listed, please fill out the form below.

Guardian Name *
Guardian Address *

Please send a copy of the Guardian's Driver’s License by mail to: Dean of Student Life and Culture Office, 8328 Georgetown Pike, McLean, VA 22102 or email it to: DOS@madeira.org. If you have any questions, please call us at 703-556-8211.