Skip to content Home Academics Undergraduate Equivalency Certificate Courses Graduate Internships Music Therapy Clinic Student Organization Directory Contact Us Music Therapy Clinic Referral Please complete the form below to be considered for music therapy next semester. Music therapy referrals are completed on a semester to semester basis, and placement occurs based on student availability. General Information Name Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Email address Phone number Please indicate whether you are seeking individual or group music therapy services. If you would like us to consider sending students to your site, please also complete the facility evaluation form. Individual Group Please indicate whether this referral is for an adult or a child. Adult Child Please indicate whether this referral is for adults or children. Adults Children Primary reason(s) you are seeking Music Therapy services Please include a brief description of your primary concern(s) and what you, or the person/group you are referring, hope to pursue or accomplish through Music Therapy? Referral source How did you find out about our clinic? Community Referral Word of Mouth Website Search Engine Other Please explain Other concerns or needs If applicable, please describe any accessibility concerns or other accommodations needed. Submit Leave this field blank
