Music Therapy Scholarship Application

Music Therapy Scholarship Application

Complete this application to share your eligibility and financial need for consideration.
Applicant Information
Applicant Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Age
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Relationship to Applicant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Contact
Eligibility
Previously received this scholarship?
Current music therapy services status
Financial Need
Describe your family's financial circumstances and why this scholarship would be helpful
Which of the following best describe your household circumstances?
Upload supporting documentation for financial need (optional)

Cancelof
About the Teen
Tell us about your interests, hobbies, or passions
What challenges do you hope music therapy can help with?

Other
Why are you interested in music therapy?
Community & Background (Optional)
Do you identify as a member of a historically underserved or underrepresented community?
Anything else about your background or circumstances the scholarship committee should know? (Optional)
Referral
How did you hear about this scholarship?

Other
Were you referred by someone? If so, please provide their name.
Agreement
Agreement Statements
Electronic Signature
Date

MonthDayYear
Date
Typed Full Name
Confirmation
Acknowledgment
Should be Empty:

Music Therapy Scholarship Application

Applicant Information

Parent/Guardian Information

Eligibility

Financial Need

About the Teen

Community & Background (Optional)

Referral

Agreement