* Name:

* School:

* Level (please indicate):

Bachelor

Masters

Advanced Masters

PhD

Doctoral

* Address:

* Phone Number:

* Email:

* Languages you speak:

* Other language skills:

* Time period of the internship, how many days a week, which days preferably:

* Primary Instrument:

* Other Instruments:

* Site reading skills on piano:

* Site reading skills on guitar:

* Vocal skills:

* Accompaniment skills on piano when material is unknown beforehand:

* Accompaniment skills on guitar when material is unknown beforehand:

* Previous experience in medical settings:

* Previous experience in music and clinical music therapy work:

* Please write freely about any apprehensions you have related to work in this setting:

* What is it about a medical approach to music therapy that interests you?:

* What areas are you most interested in: (check all that apply)

Adolescents

Adult

Geriatrics

Hospice

Music psychotherapeutic approach

MIDI equipment applications

Recording studio

Pain Management

Community Music Therapy

Palliative Care

Dementia and Alzheimer Care

Weight management

Stress management

Research

* Is there anything else that we should know about you or your former experience?:

Please send a video clip/DVD/audio CD with your voice, guitar, piano (and any instrument performance) that may demonstrate skills in the area of music therapeutic improvisation, site reading skills, flexibility in idioms, music therapeutic presence, MIDI familiarity, musical leadership skills or other music therapy related skills via email to imnf@centerlight.org or via postal mail to:

Institute for Music and Neurologic Function

612 Allerton Avenue

Bronx, NY 10467