Student Discontinuation / Auto-Pay Stop Form

Student Discontinuation Notice

* Indicates required field

Student Name *

First

Last

Email of Submitting Staff Member *

Coordinator Name *

First

Last

Date of Final Lesson *

Have Future Lessons Been Removed from Studiohelper? *

Yes No

Reason for Discontinuation *

Termination Fees *

The student has submitted to terminate lessons after the 10th of the month and owes $30 to terminate The student has submitted to terminate on or before the 10th of the month and does not owe a termination fee

Description / Notes *

Submit