Application for Music Therapy Support
Thanks to support from community partners, we are able to provide financial support for music therapy services! If you are interested in applying for this funding, please complete the following application.

Please note that these applications will be reviewed without the identification section. Please refrain from including identifying information in the sections following the second page.

Levels of support range from covering 15%-85% of session costs. The support level is determined by income level. An application that lacks income information will not be approved. All applicants may not be approved as funding is limited.

Please note that every client is not a good fit for music therapy. If your child is not appropriate for music therapy, they will still receive support for the initial evaluation and any therapy sessions that took place prior to discharge.

Applications are reviewed on a rolling basis. Decisions are made on the basis of qualification and current funding availability.
Sign in to Google to save your progress. Learn more
Email *
Before you proceed...
Please read through the instructions on the application carefully. Applications not accompanied by income verification information will not be considered. Applications utilizing their child's name in sections where identifying information is not to be included will not be considered.

Each application will be initially screened for these errors and then stripped of identifying information before being considered for an award.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Key Changes Therapy Services, Inc..