If you intend to attain a visa in order to attend The Loomis Chaffee School and will need an I-20 from our institution, please complete the form below as soon as possible.

If you are a US citizen or have a permanent resident card, you do not need to complete this form.

Personal Information

Last Name/Family Namerequired

(as it appears on your passport)

First Namerequired

(as it appears on your passport)

Middle Name

Date of Birthrequired (mm/dd/yyyy)

Gender*

Male Female Other

Country of Birthrequired

Country of Citizenshiprequired

International Mailing Address

Address Line 1required

Address Line 2

Cityrequired

Province/Territoryrequired

Countryrequired

Postal Coderequired

School Information

Entering Graderequired

Do you currently attend school in the US?*

Yes No

Name of the US school:required

Do you have an I-20 at present?*

Yes No

Important! Please request that the I-20 be transferred to Loomis Chaffee at the conclusion of your school year.

Please list the contact information for the DSO at your school

Namerequired

Emailrequired

Telephone Numberrequired

Contact Information

Address Line 1required

Address Line 2

Town/Cityrequired

State/Province/Region

ZIP/Postal Coderequired

Countryrequired

Phonerequired

Summer Plans

Do you plan to attend a summer program in the US that requires an I-20?*

Yes No

What is the name of the summer program?required

Signature

You agree that by typing your names below, you are electronically signing this form and declaring that the information you have provided is true and accurate.

Student Namerequired

Year of Loomis Chaffee Graduation:required

Parent Namerequired