Student Name

First Name

Last Name

Parent Name

First Name

Last Name

Will You Attend Your Final Lesson

Yes

Student Survey We love feedback! Please take a few moments to fill out this optional survey about your experience at Gracenote Classical Academy of Music. Overall, how would you rate your experience at Gracenote Classical Academy of Music?

What factors influenced your decision to withdraw from lessons?

Personal Schedule

Quality of Lessons

Not Enough Time to Practice

Cost

Teacher Issue

Location

Other

Lost Interest

Is there anything we could have done to keep you as a student?

Is There Anything We Could Have Done to Keep You

Yes

Are You Interested In Returning At a Later Date

Are there any other improvements you would like to see?

When will my lessons end and tuition stop being billed? If withdrawal is submitted on or before the 15th of the current month: Lessons will continue until the end of the current month and you will not charged the next month’s tuition. Students are billed regardless of attendance during the final lessons. If withdrawal is submitted after the 15th of the current month: Lessons will continue until the end of the next month and you will be charged full tuition for that month. Students are billed regardless of attendance during the final lessons.

Your request has been submitted but not confirmed. If you do not hear from us within 1 business day please call the front desk at (919) 337-8515

WITHDRAW

WITHDRAW FROM MUSIC LESSONS

WITHDRAWAL FORM

Location

Hours

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