MiA Instrument Request Form

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Thank you for reaching out to Music is Art to request an instrument as part of our program.

Available instruments depend on items donated to us and the condition of the item. Filling out this form puts you on our list so as items are received we'll look here to see if anyone has requested the item. Once a match is found, a quick approval process will be conducted, and we'll reach out to the requestor.

This program is only available to those in the Western New York area at this time.

If at any time you want to know the status of your request you can email info@musicisart.org
Thank you.

Requestor Name:

Your email:

Your phone:

Instrument recipient:

Recipient age:

Organization/School (if applicable)

Instrument(s) requested:

Reason you need this instrument, other organizations you've approached for assistance:

Impact receiving this instrument would have:

If we are able to provide you with the instrument requested you understand that we would require (please check each to accept)

photo of the instrument and recipient

sentence regarding the impact

permission to use the photo & text on our social media/website

Submit

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