Student Withdrawal Request Form

Student Withdrawal Request Form

(Withdrawal will be effective 30 days from date of submission)
We really want every student to succeed at Encore Music Studios, The Columbus Academy of Music, and The Westerville Academy of Music! Sometimes parents can be discouraged because lack of student's practice, student resistance, or student apathy. Our staff can offer encouragement, strategies, and support to help you and your child if this descibes your situation. Contact our director at encoremusicstudiosdirector@gmail.com or call 614-882-6681 for help now.
Student's Name*

Student First NameStudent Last Name
Contact Phone Number*
Please enter a valid phone number.
Contact Email
example@example.com
Reason for separation from music lessons*
Satisfaction with Current Teacher
Satisfaction with Administration
Overall Experience at Encore Music Studios*
Do you intend to return to lessons at a later date?

YesNo
If so, when?
Should be Empty: