Withdrawal Link Send Reflection Form

Please submit this form every time you send the withdrawal link to someone UNLESS the student is moving or graduating. It will be dropped into Alex’s label so she can help you brainstorm whether anything should have been done differently or can still be done!

Submitted By

First Name

Last Name

Student Name

First Name

Last Name

Name of Student's Teacher

First Name

Last Name

Did you have this withdrawal discussion with an adult student or a student's parent?

Adult Student

Student's Parent

Check all formats in which your withdrawal discussion with this student/parent took place

In-person

Phone

Text

If any part of your conversation took place via email or text, please copy/paste it here.

Try to keep the formatting as consistent as possible!

What reason did the student/parent give for wanting to withdraw?

Did you ask for more detail?

Did you ask the student if they enjoyed taking lessons specifically with their teacher?

If yes, what was the feedback you got? If no, explain why this question didn't seem applicable.

Did you ask the student if the instrument they were taking is the right fit?

If yes, what was the feedback you got? If no, explain why this question didn't seem applicable.

What do you think could be the REAL reason behind their stated reason? What is actually going on here?

What solutions did you offer for their problem?

Now that you've had a chance to reflect on this conversation, is there anything you can think of that you would have said differently? Any strategies you could have used? Any other solutions you could have shared with them?

Did you share your conversation with the teacher?

Yes

I'm planning to

What did you/will you say to the teacher and/or TC?

Can you think of any other possible strategies to try to save this student?

Additional Notes (not required)

Withdrawal Link Send Reflection Form

LOCATIONS:

INSTRUMENTS:

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