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Music Therapy Internship Form
Personal/Contact Information
Full Name
Phone Number
Date of Birth
Address
Email
Social Security Number
Emergency Contact
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship
Academic Information
College / University
University Address
Academic Director
Academic Director Email
Academic Completion Date
Academic Director Phone
Degree(s)
Primary Instrument(s)
Years of Study (Primary Instrument)
Video Interview: Video yourself answering each question in one minute or less. We recommend video links from YouTube. Video format must be unlisted or public for us to view.
How would you explain music therapy to a member of the medical staff at a pediatric hospital?
Please play one minute of a song that would be appropriate for a teen (must use guitar or piano)
Tell us about a time when your intervention appeared to fail during a session and discuss what you learned from it.
Tell us about a time you had to approach an authority regarding a subject.
Tell us about your strengths and your areas for growth
Please provide a YouTube link that includes a demonstration of musical skills on piano, guitar, and voice
Mock Music Therapy Session (with friends, family, etc.)
Essays - Please respond to the following questions. Limit each response to 250 words.
Why are you interested in becoming a music therapist?
What is your philosophy of music therapy?
What are your goals and expectations for this clinical internship?
What skills do you wish to enhance through this internship experience?
Acknowledgement
I acknowledge that in addition to the online application, I must submit three letters of reference (from non-relatives). These letters should address my clinical, communication, and musical skills, and at least one should be from my academic professor and include a statement of my eligibility to begin an internship. These letters must be emailed directly by the person completing the letter to mtinternship@childrens.com.
I acknowledge that in addition to the online application, I must submit three letters of reference (from non-relatives). These letters should address my clinical, communication, and musical skills, and at least one should be from my academic professor and include a statement of my eligibility to begin an internship. These letters must be emailed directly by the person completing the letter to mtinternship@childrens.com.
No
I acknowledge that in addition to the online application, I must submit three letters of reference (from non-relatives). These letters should address my clinical, communication, and musical skills, and at least one should be from my academic professor and include a statement of my eligibility to begin an internship. These letters must be emailed directly by the person completing the letter to mtinternship@childrens.com.
Yes
Requested Start Date
Requested Start Date
January start date
June start date
By signing below I acknowledge that a legal affiliation agreement with my university as well as a background check, drug test, and proof of required immunizations is necessary to complete an internship at Children’s Medical Center.
Signature
Date of Signature
Please Attach Resume, Cover Letter, and Transcripts
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