Instrument Loan Request Form

Please fill out the Instrument Loan Request form in its entirety. At the end of the form, you must select the instructor that can verify the use of the instrument that you would like to borrow and approve the loan request. The instrument will not be available for use until the loan request is fully approved by your instructor. Loan Agreement: 1. This instrument will be checked in and out by the Music Department Office. It must be returned at the end of the academic year or semester, as indicated. You must fill out a form per instrument per semester. 2. Acceptance of this instrument obligates the borrower to maintain it for the period of the loan. The borrower must provide reeds, oils, swabs, strings, other expendables, and routine maintenance at his/her own expense. 3. This instrument must be returned in the same condition as it was borrowed, barring normal usage wear and tear. In the event of loss or damage, the borrower will fund the replacement of the instrument of equal value or at list price for an instrument of the same make and model. 4. A technician selected by the Department of Music and paid by the borrower will repair damage caused by neglect on part of the borrower. 5. If the borrower fails to return the instrument by the specified return date or returns it damaged, the borrower will be financially responsible for the instrument and will be billed accordingly. 6. All instruments are due back by the end of the semester or academic year (whichever you select when filling out the loan agreement). By submitting the below form, you acknowledge and accept the above terms. Failure to comply with the Loan Agreement may result in a Bursar’s hold on the borrower’s University of Connecticut account and prevent course registration and housing selection.

"*" indicates required fields

Name*

Email Address*

PeopleSoft Number*

Phone Number*

Campus Address (Street, City, State, Zip Code)*

Home Address (Street, City, State, Zip Code)*

Requested Instrument*

Please select desired return time. Please note instruments can only be checked out for a semester or academic year. If you would like to loan an instrument for longer, please fill the request form out again at the beginning of the next semester or academic year. Summer and winter instrument loans are only granted on a case-by-case basis; please contact music@uconn.edu directly to coordinate these requests.*

Date of Request

Please list the class, ensemble, or group you will use the instrument for. Note: non-Music majors who are not currently enrolled in a departmental ensemble are unable to loan departmental instruments.

Select the instructor who can verify and approve your request.

Phone

This field is for validation purposes and should be left unchanged.