Student Withdrawal Form
Student Name
Current Class ID
Example: 40A
Family ID
Your last name following by the last 4 digits of the registered phone number. Example: Lee-1234
Number of Service Points Fulfilled
Check the number of service points fulfilled on the school website and self-report here.
Effective Date
-
Month
-
Day
Year
Reason
We deeply value the input of all our students and families and are grateful for any suggestions that can help us improve our school.
Parent Information
Name
Email
Phone Number
Format: (000) 000-0000.
Address (required if you choose to refund by check)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Refund Information
We will issue a refund to the account you used to pay the tuition. Please provide the corresponding account information of your choice.
I paid via PayPal
I paid via Zelle
I paid by check
PayPal/Zelle account name
Check payable to
Note
Submit
Should be Empty: