CMS Withdrawal Form
Please fill out this form to officially withdraw from one or more classes or lessons student applied or registered for.
Student Full Name
*
First Name
Last Name
Parent Name (if student is a minor)
First Name
Last Name
Primary Email of Parent or Adult Student
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please list each class, orchestra, and/or private lesson the student is withdrawing from. Please include the instructor's name.
*
Please include instrument or class name & instructor
Reason for Withdrawal
*
Has the instructor been informed of student's intent to withdraw?
*
Yes
No
Date of last lesson or class attended (for each withdrawal):
*
How would you prefer to receive any tuition or fees that may need to be reimbursed to you in response to this withdrawal?
*
Please Select
Please process a refund for the amount due
Please apply the reimbursement amount as a credit to my account for future semesters
Please apply the reimbursement amount to other charges currently on my account (other students or tuition, etc)
I have no preference
Amount of reimbursement, if any, is determined by the CMS Artistic Director and the CMS Payment & Withdrawal Policy below. $25 New Student Application fee is NON-refundable but can be carried over to future semesters.
Special Requests or Additional Information
Please let us know if you have a special request or circumstance, or need other acccomodations.
Signature
Please verify that you are human
*
Continue
Continue
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