Therapeutic Musician Intensive Application 1 Program Information2 Personal Information3 Musical Background4 Experience & Training5 Your Goals Program InfoThis application is for admission to the following season*SeasonFall 2019Winter 2020Spring 2020Summer 2020Fall 2020Personal InfoLegal Name* First Middle Last Name You Would Like To Be CalledAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Best way to contact you if there is a cancellation:Phone callText MessageEmail Musical BackgroundDo you have any music training in your background? If NO, please proceed to question #5 ; if YES, please answer the following:1. Please indicate the instrument(s) you wish to play in healthcare: Harp Voice Guitar Keyboard Dulcimer Other 2. Do you read music? Which clef(s)?3. What is your level of proficiency on the instrument(s) you listed above?4. Please indicate the nature of your musical training and experience. Do you play by ear? Improvise? Do you write your own arrangements? Your own music? Do you take lessons? With whom have you studied? Do you teach music? Do you perform? Where? Please elaborate.5. What genres (classical, pop, oldies, hymns, Broadway, etc.) are your favorites to play and/or sing in?6. What is your favorite kind of music to listen to? Experience & TrainingHave you already had experience playing music at the bedside of the ailing?In front of a group?In a public area in a health-care facility?Where and for how long?Do you have any medical, healthcare, hospice or spiritual care experience? If so, please describe.Do you have any training and/or credentials in any alternative or integrative health care? If so, please describe.Do you have a regular practice/ritual for stress relief?Have you recently experienced a loss? Please describe.Do you have any credentials from other healing and/or sound healing institutions? If so, please describe. Your GoalsWhat do you see as your main goal after you achieve a Bedside Harp's intensive training course?What audience of people and/or what kind of medical facility do you think you would like to work with?What kind of audience of people and/or what kind of medical facility do you think it would be difficult for you to work with?What strength of yours do you believe you will be able to draw upon in the work?What would you consider to be an area or areas you believe you’ll need to work on as you prepare to do this work? Education/Work ExperienceEducation: Please include high school, vocational school, college, graduate school.Work: Please summarize your professional/work experience:Where did you first hear of our program?Please mark all that apply: Recommendation Mailing Internet Facebook LinkedIn Instagram Harp Therapy Journal Somerset Harp Festival Referral Other If other, please specify:Additional CommentsAdditional CommentsRegistration InformationTuition for Modules I through IV and materials fee will be made directly to Bedside Harp. Please complete this application, along with an informal recording of yourself playing ten tunes, very simply, on the instrument(s) you indicated above, to the address Bedside Harp 4802 Neshaminy Blvd. Suite 3-4 Bensalem, PA 19020, or e-mail them as attachments to firstname.lastname@example.org and email@example.com. There are two payment plans: (1) Pay for all classroom modules and materials 30 days prior to the start of Module I and receive a 5% discount. (2) Pay as you go: You would pay for the module and that modules materials fee ($60.00 per module)10 days before the start of that module. Bedside Harp regrets that we are unable to offer refunds within fourteen days of the start date of our modulesNameThis field is for validation purposes and should be left unchanged.