Notice of Student Discontinuation - Holy Names Music CenterHoly Names Music Center

(To be completed by the teacher)

The student described in this form has paused or terminated their instruction at Holy Names Music Center.

Teacher Name(required)

Student Name(required)

Did the student discuss with you their reason for discontinuing?(required)

Why is the student discontinuing lessons?(required)

Did you try to find a resolution? Indicate N/A if not applicable.(required)

On what day did the student tell you they were discontinuing lessons?(required)

Students are required to give 2 weeks notice before discontinuing lessons. On what date did or will the final lesson occur?(required)

Is the student planning to return to lessons at a later date? Please provide our office with appropriate details.(required)

Enter all lesson dates you will bill for current month through last lesson date (+ any not recorded during year that should have been):(required)

Add all remaining lesson dates to this month's time sheet, even if they extend into the next month. Use extra lines at bottom of time sheet if needed & label as Student Name cont.

Is there any other information you would like to share with our office?(required)

Thank you!

Your response will be emailed to the office once you press submit.