Change Request Form

Midwest Elite Dance Center

CLASS CHANGE REQUEST FORM
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Change Category (Check all that apply)

Other
Parent/Guardian

First NameLast Name
Class Name
Student Name

First NameLast Name
Project Owner

First NameLast Name
Priority
Project Phase
Form must be submitted by the second week of the month. If this is not done you are responsible for the full payment that month.
If Requesting to Withdraw, Indicate the Date of Last Class

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Indicate Reason for the Change
Benefit/Reason for change:
Describe any technical changes required to implement this change:
Describe risks to be considered for this change:
Signature
Should be Empty:

Midwest Elite Dance Center