CMCP Level 3 Vibroacoustic Therapeutic Music Application

Admission and final assessment decisions will be made without discrimination based upon gender, race or religious affiliation. Please note that healthcare institutions usually have a minimum age requirement of 18 to play at the bedside, so age may affect your ability to complete the internship requirement.

Date:

Name:

Address:

City:

State:

Country:

Zip or Postal Code:

Phone:

E-Mail:

Name of the NSBTM Accredited Therapeutic Music training program you completed (Required for enrollment--check all that apply) By completing this section, you are granting Harp for Healing, LLC permission to contact your therapeutic music training program if necessary to confirm your graduation and CEU status.

Bedside Harp

Harp for Healing CMCP

International Harp Therapy Program

Music for Healing and Transition Program

Healing Harp

Date therapeutic music training completed:

Continuing Education Requirements up to date? Yes No Uncertain

What instrument(s) do you play?

Please describe your therapeutic music experience, including your current practice:

Clinical Musician Certification Program LEVEL 3 Student Agreement

I agree that I will review the course materials, graduation requirements, and expectations of the CMCP Level 3 program upon receipt. If I decide not to pursue the program after reviewing the materials I will indicate to the home office my desire to withdraw within 20 days of enrollment and will delete or destroy all copyrighted materials sent in PDF or other electronic form and return the hard copy of the CMCP Level 3 textbook if it was ordered. I will receive a refund of my tuition and book payment less a processing fee of $125 once all these conditions are met.

I understand that the course materials are copyrighted and may not be copied or shared with anyone not registered in CMCP Level 3. I agree that I will not inappropriately use the program’s copyrighted materials, nor will I teach these materials to others.

I agree to conduct myself in accordance with the Code of Ethics & Conduct of my therapeutic music training program.

I understand that I may be subject to revised requirements if I have not completed the program for which I am registered within two years. I understand that I will have a mentor assigned and that it is my responsibility to make regular assignment submissions and make regular contact with my mentor. I understand that six months of no contact with my mentor and/or no assignment submissions will result in being automatically designated as inactive and will need to pay a reactivation fee in order to be reactivated.

I understand my mentor and the program office are available to answer questions regarding program materials and requirements.

Please check the box to indicate you have read and agree to the terms stated above.