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Online Locker Request Form
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Online Locker Request Form
If you see this don't fill out this input box.
To request permission to use a PennWest Clarion Department of Music locker to store your personal instrument, please complete and submit the form below. Lockers will not be assigned for storage of personal articles other than musical instruments. If you need to store more than one instrument, please fill out a separate form for each instrument and indicate that you need storage for multiple instruments in the COMMENTS area below.
*
Last Name
*
First Name
Local Address
*
Street Address
*
City
*
State
*
Zip
*
Local Phone Number
*
Mobile Phone Number
*
Email
Instrument Type
Piccolo/Flute
Clarinet
Bass Clarinet
Oboe
Bassoon
Alto Saxophone
Tenor Saxophone
Baritone Saxophone
Soprano Saxophone
Trumpet
Horn
Trombone
Bass Trombone
Euphonium
Tuba
Violin
Viola
Cello
Bass
Guitar
other
*
Instrument Make
*
Instrument Serial Number
Semester Locker Requested
Fall
Spring
Academic Year Locker Requested
Academic 2019-20
Academic 2020-21
Academic 2021-22
Academic 2022-23
Comments / Special Instructions Use the area below for any additional comments. Also, indicate below if you have any locker preference (i.e. specific locker number, high or low, location, etc.)
Submit
Reset
Last Updated 5/30/23