BKCM Suzuki Withdrawal Form
Student's First Name *
Student's Last Name *
Parent's First Name *
Parent's Last Name *
Survey Completed By: *
Private Lesson Teacher
Previous Private Lesson Teacher
If previous teacher is not listed above please enter their name here:
Are you involved with any of these other BKCM offerings? *
Would you be interested in receiving information regarding any of these programs? (Select all that apply)
Please select the age of the student *
Whose decision was it to withdrawal? *
Would you like to remain involved in Suzuki-alumni activities when possible?
Clear selection
Will the student continue to study music? *
What were highlights of your Suzuki experience?
What are aspects of our program that you would recommend we improve or change?
What are your reasons for withdrawing? (choose all applicable) *
If you would like to clarify, or in if none of the above options apply, please write in your own words the reason(s) for withdrawing.
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