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Discontinuation Form

- Step 1 of 4

Student's Name *

First

Last

Name of Parent/Guardian (if under 18 yrs old)

First

Last

Reason For Discontinuing *

Taking A Short Break
Life Is Getting Too Busy
Lack Of Interest
Scheduling Was Too Difficult
Distance Too Far
Unhappy With The Lessons
Price Is Too High
Other Reasons Not Stated Here

How satisfied were you with the instructor you had? *

5 (Very Satisfied)
4
3
2
1 (Not Satisfied)

How knowledgeable did you feel your instructor was in his/her field? *

5 (Very Knowledgeable)
4
3
2
1 (Not Knowledgeable)

How well did your instructor explain the material? *

5 (Very Well)
4
3
2
1 (Not Well)

Did your instructor give you things to work on and practice at home after every lesson? *

5 (All The Time)
4
3
2
1 (Never Did)

Was your instructor positive and encouraging during your lessons? *

5 (Always)
4
3
2
1 (Never)

How would you rate your experience in scheduling or rescheduling your lessons? *

5 (Very Easy)
4
3
2
1 (It Was Difficult)

How would you rate our communication and service at our front desk? *

5 (Excellent)
4
3
2
1 (Poor Service)

How would you rate the cleanliness of our facilities? *

5 (Very Clean)
4
3
2
1 (Very Filthy)

Please let us know if there was anything we could've done to better serve you.

Checkboxes *

I acknowledge that any and all unpaid invoices have been paid, and that Encore School Of Music is authorized to charge my credit card on file for any balance due.

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