POSA Instrumentarium Loan Application Form

Name_____________________________________________________

Address___________________________________________________

Home phone_________________ Work Phone__________________

School/Organization_______________________________________

Dates of loan:
1st choice_____________________________________________________
2nd choice_____________________________________________________

Experience: Please describe your music/education background, including Orff-Schulwerk training and workshops:






Proposal: Describe your intended use for the instrumentarium. Include age levels and number of students served and briefly summarize your curriculum goals (use more space if needed).








Storage: Please explain how the instruments will be stored when not in use.




 Applicant signature_______________________________________________   Date_______

Received by POSA Board_____________________________________________________

Action Taken_____________________________________________________


Date instruments will be picked up by applicant _______

Date instruments will be returned by applicant ______