Change Request Form

Midwest Elite Dance Center

CLASS CHANGE REQUEST FORM
Date *

Month Day Year
Date
Change Category (Check all that apply) *

Withdraw from Class Change From One Class to Another
Parent/Guardian

First Name Last Name
Class Name
Student Name

First Name Last Name
Project Owner

First Name Last Name
Priority

Drop Class Change Class
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

Month Day Year
Date
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

Clear
Should be Empty:

Midwest Elite Dance Center