Day Sessions: ABLE Summer Music Program Application

Please complete this form to apply for the Day Sessions: ABLE summer music program for musicians with disabilities, ages 9–17 (older students can participate on a case-by-case basis). Applications will be reviewed by our team, and Dr. Rhoda Bernard, the Berklee Institute for Accessible Arts Education managing director, will contact you directly to arrange a follow-up meeting and/or phone call.

NOTE: The application deadline for summer 2024 is July 1, 2024. For questions or for more information, please contact Rhoda Bernard by email at rbernard@berklee.edu or by phone at 617-747-2760.

Thank you for your interest in our program; we look forward to meeting you soon.

Student Information

Student's Legal First Name

Student's Preferred First Name

Student's Legal Last Name

Student's Preferred Last Name

Student's Age

Students in Day Sessions: ABLE must be no younger than age 9. Students older than age 17 can be considered for the program on a case-by-case basis.

Student's Date of Birth

Legal Sex Designation

If you would like to self-identify gender, please do so here:

Pronouns are one of the ways we embrace our identities. Please let us know your pronouns so that we can address you correctly. What are your pronouns

Name of the School the Student Attends (as of September 1, 2022)

Grade Level (as of September 1, 2022)

Citizenship

Country of Citizenship

Country of Birth

Colleges and universities are often asked by the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our community members. In order to respond to these requests, we ask you to answer the following question:

Please check one or more of the following groups in which you consider yourself to be a member:

Primary Language

Student's Specific Diagnosis

All students in Day Sessions: ABLE must have a diagnosed disability. Students who do not have a diagnosed disability cannot participate in this program.

Family Information

Parent or Guardian's Name

Parent or Guardian's Email Address

Parent or Guardian's Relationship to the Student

Parent or Guardian's Phone Number(s)

Parent or Guardian's Address Line 1

Parent or Guardian's Address Line 2

City

State/Province

Postal Code

Country

Program Information

Application for Program Week(s)

Participation is dependent on acceptance to the program and availability.

Student's Primary Instrument

How long has the student been playing the instrument?

Does the student take music lessons?

If so, how long has the student been taking music lessons?

Name of Student's Lessons Instructor

Please provide any information that will help us to better understand the student and the student's musical needs.

Please describe in detail any behavioral issues that the student may have that might impact the lesson, and provide information about ways to manage those issues effectively.

Please describe in detail any attention issues that the student may have that might impact the lesson, and provide information about ways to manage those issues effectively.

Please describe in detail any sensory issues that the student may have that might impact the lesson, and provide information about ways to manage those issues effectively.

How did you hear about this program?

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