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2025-2026 EIU Music Department Instrument Check Out Form

Please fill out all required information. If you have questions, please ask David Boggs or Charles Koprowski-Barr PRIOR to submitting the form to avoid having to re-submit a second form.

Name Name First Last
Cell Phone Cell Phone - ### - ### ####
EIU Email
Specific Instrument (Flute, Alto Flute, etc.)
Instrument Brand (Yamaha, Jupiter, Armstrong, etc.)
Instrument Model (YHR762, etc.)
EIU Instrument Locker Number
EIU Instrument Lock Number
(3 to 6 digits on the back of the combination lock)
EIU Instrument Lock Combination
(ex. if the combination is 13-07-42 JUST list the six digits - 130742 - with NO dashes)
Instrument Serial Number
(usually a 5-6 digit sequence BUT it could include letters)
Instrument Red Tag Number
(Red Tag is usually located on the case)
Instrument White Tag Number
(White Tag is usually located on the case)
EIU Instrument Number
(located on the case - ex. BTB-01). If the form will not submit with the letter and numbers then just submit the form with the number ONLY (ex - 01).
Does the instrument have a university-owned mouthpiece?

Does the instrument have a university-owned mouthpiece? Yes No
Please list all accessories included (cleaning rod, cleaning cloth, valve or key oil, slide cream, cork grease, etc.)
Does this instrument have any cosmetic damage of any sort? Please describe in detail.

Does this instrument have any cosmetic damage of any sort? Please describe in detail. Yes No
笔濒别补蝉别听fully聽explain the repair needed.

You must do this to turn it in!
Your instrument will need to be fully cleaned prior to returning it. Please indicate your understanding this requirement in the box below.

Your instrument will need to be fully cleaned prior to returning it. Please indicate your understanding this requirement in the box below. Yes

You must do this to turn it in!
Your case will need to be cleaned out and vacuumed prior to returning it. (Vacuum located in GA office.). Please indicate your understanding this requirement in the box below.

Your case will need to be cleaned out and vacuumed prior to returning it. (Vacuum located in GA office.). Please indicate your understanding this requirement in the box below. Yes

You must do this to turn it in!
The locker that houses your EIU instrument will need to be cleaned out and wiped with an alcohol wipe prior to turning in your instrument. Please indicate your understanding this requirement in the box below.

The locker that houses your EIU instrument will need to be cleaned out and wiped with an alcohol wipe prior to turning in your instrument. Please indicate your understanding this requirement in the box below. Yes

You must do this to turn it in!
What ensemble is this instrument PRIMARILY used for?
Wind Symphony Members ONLY - Will you need this instrument for spring graduation?

Wind Symphony Members ONLY - Will you need this instrument for spring graduation? Yes No

You must do this to turn it in!
Instrument turn-in dates for Spring Semester will be as shown below in the Band GA Office (#0354). Instruments being used for graduation will be turned in immediately following the last graduation ceremony.

Instrument turn-in dates for Spring Semester will be as shown below in the Band GA Office (#0354). Instruments being used for graduation will be turned in immediately following the last graduation ceremony. Tuesday, May 5, 2026 Wednesday, May 6, 2026 Thursday, May 7, 2026 Saturday, May 8, 2026 (Wind Symphony ONLY!)
I have read the EIU Instrument/Equipment Policy below and with my signature agree to all term of the agreement.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
EIU INSTRUMENT/EQUIPMENT POLICY

EIU owned instruments are equipment are available to students of the University for use in EIU performing groups and/or for private lessons taken through the University during the regular academic year. A person using an EIU instrument or EIU-owned equipment is expected to abide by the following regulations, with any infraction resulting in the loss of privilege to use the instrument/equipment.

1. The non-refundable fee for rental of the instrument/equipment will be as follows:
鈥� $225/year for Music Majors renting their primary instrument.
鈥� $60/semester for Music Minors, Majors for secondary instruments.
鈥� $40/semester for Non-Music Majors or Non-Music Minors, and all Athletic Bands

2. Payment can be made online using the EIU Cash Net System at https://commerce.cashnet.com/eiumusic4
or by cash/check at the Band Office. Make checks payable to EIU. Rental fees are due by the Friday of the 4th week of the term of rental. If not received, the instrument will be removed from the EIU locker and held in the Band Office until paid.

3. EIU instruments are to be kept in EIU lockers, including the red lockers for personal storage, when not in use.

4. An EIU instrument/equipment is issued in good working order. Any malfunction should be reported immediately to the Band Office. The person issued the instrument/equipment will be responsible for the proper care and cleaning of the item issued until it is officially checked in. Normal maintenance and repairs will be done by the Department of Music at no charge to the student. Repairs needed due to improper use or neglect, however, will be charged to the student.

5. EIU instruments/equipment are intended for the use in EIU ensembles/lessons. If the ensemble/lesson is dropped, the instrument/equipment is due immediately. (Fees are non-refundable)

6. Instruments and accessories should never be left unattended. If any faculty or the Inventory Graduate Assistant finds an instrument and/or accessory left unattended it will be taken to the Band Office. A $5.00 fine will be assessed to retrieve the abandoned item.

7. All instruments/equipment are to be checked in on or before the Wednesday of finals week of the term of rental. The student who checked out the instrument/equipment must personally return it to the assigned locker or the Band Office by the due date.

8. If the instrument/equipment is not returned by the last day of finals week, the student will be charged a $20 late fee. The student will also be reported to the University Police and/or the EIU Office of Student Standards.

9. When checking in an instrument, be sure to check in any accessories separately, such as mouthpiece, ligature, neck or seat straps, bocal, or bow. The full replacement cost of the missing item(s) will be charged to the student.

10. A 鈥淐ommunity Instrument,鈥� is one that is issued to more than one student and is indicated below. The instrument must be kept in the assigned locker unless actively being used. It is the responsibility of the students to work out rehearsal/performance times by filling out the Instrument Usage Card located in the locker. New Usage Cards can be obtained in the Band Office.

11. Students should not switch instruments/equipment with other students. The student who originally checked out the instrument/equipment is responsible for any damages to or the loss of these items until check-in at the end of term.

12. Charges for late return, missing instruments/equipment, and damage are the responsibility of the student. The student will not be allowed to rent another instrument/equipment until payment is received.

13. EIU-owned instrument/equipment may be checked out by music majors and students in applied lessons over the summer or between terms with the approval of Professor Boggs.