ࡱ> 130y zbjbj 4{{z (((((<<<<X<!vlllllGGG$Ir(4GG44((ll4 (l(l4lBg> 0!H(G"iGGG^FGGG!4444GGGGGGGGG : Guardian Statement The District (District) cannot take any legal, financial, or personal responsibility for any minor student, international or domestic, enrolled in our college. Therefore, requires that international students who are under the age of 18 have a designed guardian over the age of 21 living in San Diego County. A designated U.S. guardian must be present for the entire duration of the F-1 visa program, as administered by the Department of Homeland Security. In the event of a personal emergency, accident, illness or incarceration, the State of California will require the signature of a guardian before assistance such as hospitalization or legal counsel is administered. is not permitted to act in place of the parent or guardian. If the student is under age 18 as of the first day of school, the following information must be provided and signed by a local guardian and parent of the student: NAME OF STUDENT: ________________________________________________________________ Family Name First Name DATE OF BIRTH: __________________________ F-1 Visa Status: ___________ Month/Date/Year SEVIS # DESIGNATED U.S. GUARDIAN I understand and agree to take full responsibility for above named student for all matters including any medical, legal, financial and personal matters until the student reaches the age of 18. I am obligated to notify the District and the dependents parent if my status as Designated U.S. Guardian or legal residence changes. PRINTED NAME OF GUARDIAN: ______________________________________________________ SIGNATURE OF GUARDIAN: _______________________________ DATE: _________________ ADDRESS OF GUARDIAN:____________________________________________________________ ____________________________________________________________ PHONE NUMBER OF GUARDIAN: _____________________________________________________ PARENT By completing and signing this form, I agree that the person named above will act as guardian for my child until he/she reaches the age of 18. 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