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

FallSpring

Academic Year Locker Requested

Academic 2023-24 Academic 2024-25 Academic 2025-26

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.)

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