MUSIC THERAPY INTERNSHIP APPLICATION

The Music Therapy Internship Application is a joint application for Internships at the NSHA (QEII Health Services Sites) and the IWK. All applicants will be reviewedjointly by NSHA and the IWK.

Please note that all interns are required to meet either the NSHA and IWK pre-placement requirements (or both) prior to the start of the internship. Details regarding pre-placement requirements can be found on the NSHA Student Learner Website (link below). The IWK’s pre-placement requirements are similar to NSHA. If an applicant is successful and is offered a music therapy internship – full details regarding requirements will be communicated to the applicant. As a part of this application process – please review the requirements (particularly the immunization requirements) to ensure you will not have any difficulty meeting the requirements should you be offered an internship with the NSHA or IWK.

2017 Application Deadline: March 31st, 2017

Application Checklist

Before submitting, make sure the following is included:

  • Completed Application Form
  • Transcripts from all educational institutions pertinent to Music Therapy.
  • Two letters of reference (i.e., volunteer, educational, work).
  • Resume/CV
  • Goal Statement
  • Signed Music Therapy Internship Application Agreement

Application Instructions:

1.Please email one PDF copy of this application form to: Please ensure the email subject line states “MUSIC THERAPY INTERNSHIP APPLICATION”

2.Please mail one complete application package that includes: Application form, transcripts, two letters of reference, resume, goal statement, and signed application agreement. Mail the application package to:

Nova Scotia Health Authority

c/o Student Learner Placement Services

Rm 235 Bethune Building

1276 South Park Street

Halifax, NS

B3H 2Y9

Further detail regarding pre-placement requirements can be found on the NSHA Student Learner Placement Website or by calling (902) 473-6378

Please complete the following information:

(Please type or print.)

Personal Data

Name:

(Last)(First)(Middle Init.)

Present Address:

(Street, Apt No.)

(City)(Prov./State)(PC\Zip)

Phone: (home).(day). Effective Until:

E-mail Address: Fax #:

Is English your first language? Yes ( )No ( )

Permanent Address:

(Street, Apt No.)

(City)(Prov./State)(PC\Zip)

Preferred start date: ______

Please rank which internship site you prefer: (1 = first choice, 2 = second choice, etc.)

____ Long Term Care (Camp Hill Veterans’ Memorial Building, NSHA)

____ Palliative Care (Victoria General, NSHA)

____ Pediatrics, Child & Adolescent Mental Health (IWK Health Centre)

Educational Information

Beginning with your most recent experience, please list all schools attendedpertinent to music therapy. Attach additional pages if necessary.

Unofficial transcripts must be submitted with the application.

Name of School / Prov.
City/State / Dates Attended
From To
Mo/Yr Mo/Yr / Major /
Degree
/ Date
Degree
Awarded

If your internship is included as a part of your Music Therapy Degree, please also provide the following information:

Name of Educational Institution: ______

Name of faculty or internship coordinator: ______

Title:______

Email address: ______

Telephone number: ______

Educational Program: ______

Course number: ______Year of Study:______
Goal Statement

On a separate page, please type a personal goal statement for the internship site you ranked #1 on page 2 that discusses the following questions. Begin this statement by listing your name and the internship to which you are applying.

1)What experiences have you had in the healthcare field?

2)What related academic course work/continuing education do you have in progress or planned?

3)What related school or community activities have you participated in?

4)Why do you feel you are a good candidate for this program?

5)Why do you feel you are suited to work in

Please choose one of the following:

  • long term care
  • palliative care
  • pediatric health care

Where did you first hear about the music therapy internship placement?

 Recruitment Fair Internet/Web School Counsellor/Teacher/Professor

 Family/Friend Employer Media, specify:_

 Other, specify:______

Music Therapy Internship Application

AGREEMENT

Please read carefully and sign below.

The information in this application is accurate and complete to the best of my knowledge. I understand that falsifying or omitting information on this application may disqualify me or subject me to dismissal.

I have reviewed the pre-placement requirements on the NSHA student learner website and understand it is my responsible to complete all requirements prior to the start of an internship should I be offered an internship at NSHA/IWK.

Signature(required before application can be processed) Date

P:\My Documents\internships\internshipforms\Internship Application FormupdateddraftAug2015.doc

Revised Jan. 2005

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