EMS102e – Change of Provision Request

This form is for schools to request changes to their music provision provided by Ealing Music Service.

Complete one form per provision e.g. if schools wish to change two different provisions, two different requests must be submitted.

Please note the following:

Notice of one half-term is required for any changes to a provision.
Any requests must be in line with EMS Service Level Agreement and must be authorised by EMS before any changes are implemented.

School

Position in School

Name

Email Address

Teacher

Type of Provision

Day of Tuition

Time of Tuition

State using 24hr clock e.g. 13:00

Duration

Hours : Minutes

(Total in Minutes)

Type of Change

What would you like to change?

Anything Else?

Would you like to change anything else?

Changes from Term

When would you like the changes to happen?

Agreed with the EMS Teacher?

Have these changes been discussed and agreed with the EMS Tutor?

Additional Notes

Submission Agreement

I am submitting this as an authorised member of staff of the school named above.