Harmony Music Therapy $300 Scholarship Application
Thank you for your interest in Harmony Music Therapy! We are thrilled to be able to offer one $300 scholarship to benefit children with special needs age 0-18 in group or individual settings.
Child Name (person who will receive services)
Your answer
Parent/Guardian Name (contact person)
Your answer
Relation to child
Your answer
Email
Your answer
Phone
Your answer
City of Residence
Your answer
How did you hear about Harmony Music Therapy?
What is your annual household income?
# Dependents
Child Age
Your answer
Child Diagnosis (if any)
Your answer
Please describe any concerns you have about your child
Your answer
Why are you seeking music therapy for your child? What do you hope to gain?
Your answer
Please list any other services your child is currently receiving
Private pay
Paid for by outside party
Speech Therapy
Occupational Therapy
Physical Therapy
Applied Behavioral Analysis (ABA)
How much would you be able to comfortably be able to pay toward each weekly session? (please note that the more you are able to contribute the longer we will be able to provide services).
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