Application to Request a Piano
Full Name *
Address, including City, State, and Zip *
Best Phone Number for Reaching You *
E-Mail Address *
Who will be playing the piano? *
Is there a specific reason you feel a piano will benefit this particular individual? *
Please elaborate in 2-3 sentences.
How many people live your household including yourself, and what are their ages? *
This helps us measure the impact of our organization. Thank you!
What is approximate total monthly income of your household? Please include spouse/partner income. *
It is important that our pianos are first available to applicants with limited financial resources.
Do you receive any type of assistance or income outside of a job, and if so, what kind? *
Please describe where the piano will go in your residence -- about how many steps would be involved in getting the piano from the curb to your first floor? *
Would you mind telling us how you learned about Pianos for People?
This helps us improve our ways of spreading the word to others like yourself.
In an effort to know the diversity of recipients Pianos for People are reaching, please give your ethnic origin.
Sex *
Marital Status *
Please upload proof of income. Please contact Amy if you have questions about acceptable documentation at
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