Series application | EchoBridge MT

application form

First name

Last name

Email

Country

State

Are you 18+

Yes

No

What draws you to this group?

Feeling unheard

Wanting a creative outlet

Wanting to connect with others who understand

Curious about music therapy

Do you have access to a private space and reliable technology (i.e., device, internet)

Yes

No

What is your time zone?

What times are preferred? Please select all that apply.

Morning (9am - 12pm)

Early afternoon (1pm - 4pm)

Late afternoon (4pm - 6pm)

Evening (6pm - 8pm)

Do we have your permission to reach you by email?

Yes

No

If enrolled, are you able to commit to (6) six weekly 75-minute virtual sessions?

Yes

No

I acknowledge this program is not equipped for crisis support, if you're in crisis, contact 988

This pilot is currently open to residents of select U.S. states,

we'll follow up if we need more information