Student Withdraw Form

Should it become necessary to discontinue classes for any reason, you must notify the office in writing.  A student withdrawal form is required or ADA retains the right to keep the students enrollment status active and charge accordingly.  You are financially responsible for tuition payments up to the time of such action. 

Student Name:

(Please print neatly)

Phone Number:

Today’s Date:                                               Date of Withdraw:

Class Schedule:

Reason for Withdraw:

Parent/Guardian Signature