Please complete this form to request a School of Music instrument or coat locker. Please note: a $20.00 charge will be applied to your U-bill for each locker checked out. Student must sign this form electronically before a locker will be issued. 1 Start 2 Complete First Name * Last Name * UNI ID # * Address * Phone Number * E-mail Address * Which building would you like a locker in? * - Select -Russell HallGallagher Bluedorn Which type of locker would you like? * - Select -Coat LockerInstrument Locker Please list the instrument(s) you play, and what you will need to store in your locker: * At least one instrument must be noted in order to be issued an instrument locker. If you plan to store multiple instruments/items, every effort will be made to accommodate your request. All lockers are the property of the University of Northern Iowa School of Music and may be inspected or re-claimed by the director or their designee at any time. All responsibility for the care and protection of belongings stored inside of lockers rest with the person to whom the locker has been issued. The university is not responsible for lost or damaged items. If the student to whom a locker has been issued withdraws from class for any reason, the locker must be vacated immediately. Lockers must be cleaned and emptied by midnight on the last Thursday of each semester. If lockers are not emptied at that point, all found items will be disposed of and the student to whom the locker has been issued may be charged a $5.00 cleaning fee on their U-bill. The School of Music will not be responsible for any items left in lockers. I have read the above statements of policy regarding the use of lockers owned by the University of Northern Iowa School of Music. I understand the policies fully and agree to comply with all policies. I also understand that a $20.00 charge will be applied to my U-bill for each locker checked out per year. Electronic Signature * By typing my name here I agree to the policy outlined above. Leave this field blank
