National Roster Internship Application, revised 1/2028, AIAC Committee Page 1
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
NATIONAL ROSTER INTERNSHIP APPLICATION
Facility/Program Name:
Address:
Telephone:
Email Address: (please note that most correspondence will be via email)
Proposed Internship Director Name (Include AMTA Member Number and CBMT
Certification Number):
Supervising Music Therapist Name(s) (Include AMTA Member Number and CBMT
Certification Number):
Licensure/Certification of Site(s):
Will your site require a legal affiliation agreement with the intern’s academic
institution?
Yes No
Population served:
Internship Director Information:
How many years have you practiced music therapy? (indicate full or part time)
How long have you worked at your present facility? (indicate full or part time)
Please note that applications will NOT be reviewed when the applicant
Internship Director has less than 12 months experience in the facility.
How many hours of direct music therapy contact do you provide each week?
List your credentials:
Have you ever been reprimanded or sanctioned for misconduct or found negligent
in your professional practice?
Yes No
(If yes, please provide more information):
Supervising music therapist information: (complete for each supervising music
therapist)
How many years has each applicant practiced music therapy? (indicate full or part
time)
How long has each applicant worked at the present facility? (indicate full or part
time)
How many hours of direct client music therapy contact does each applicant
provide each week?
National Roster Internship Application, revised 1/2028, AIAC Committee Page 2
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
List all applicants’ credentials:
Has any applicant ever been reprimanded or sanctioned for misconduct or found
negligent in their professional practice? Please answer for each applicant.
Yes
No
(If yes, please provide more information):
Application Checklist – Please note that incomplete applications will not be
reviewed
National Roster Internship Application
Statement of Original Work
Fact Sheet
Philosophy Essays
Sample Internship Schedules
Forms
Application for Internship
Orientation Checklist
Competency-Specific Evaluation/Self-Evaluation
Site Evaluation Form
Intern Dismissal Policy and Procedure
Resume/Vita for all applicants
Letters of Support/Recommendation
Responsibility Statements from all applicants
Certificate of Supervision Training (or approved alternative – please see the
application for more information)
STATEMENT of ORIGINAL WORK: I verify that the information included in the
application for a National Roster Internship Program is my original work unless
otherwise cited.
Name:
Facility Name:
Date:
(Submitting an application via email implies electronic signature by the applicant.)
National Roster Internship Application, revised 1/2028, AIAC Committee Page 3
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
Attachments
Please attach the following items as separate pdf documents or attach as
one pdf document but with each section clearly labeled and in
consecutive order as presented below:
A. Fact Sheet: This will be a personalized document for your specific internship
site, suitable for distribution to prospective interns, academic sites, and
professional colleagues, including at least the following information:
Name and address of internship site
Name and contact information for the Internship Director
Description of population served
Description of entry level requirements/competencies (e.g.: examples of
experience and/or recommended skills (music, clinical, professional, etc.)
which may be needed for your specific population)
How entry level requirements/competencies will be evaluated (e.g.:
interview, audition, on-site visit)
Description of the internship experience. What should the intern expect to do
at your internship program? Whom will the intern work with? List the number
of hours of work per week, and any other information of interest. Describe
the intern’s schedule – will they be leading large groups? Small groups?
Individual sessions? How much time will the intern spend with each MT-BC?
Describe your philosophy of music therapy and training interns for
prospective applicants. What meetings, assignments, or projects will interns
do while in your program?
Description of professional staff working with the intern (list music therapy
staff and describe all other professional disciplines with whom the student
would have contact/interaction during internship)
List other on-site student training programs (e.g., does your site also train
occupational/physical therapy students, social work interns, nursing
students, medical interns, etc?)
List other on-site educational programs offered at or near your site (e.g.:
inservices, professional conferences, workshops, educational meetings, etc.)
Information on the following items: available housing, meals, stipend,
transportation and liability insurance. Indicate whether these items are
available or not.
Other applicable site-specific administrative requirements that will affect
acceptance to internship: State what requirements need to be met/approved
prior to the intern’s start date as applicable (legal affiliation agreement, CPR
training, health and drug screen, finger printing, criminal background check,
etc). Please state if any of the listed items will require related fees to
be paid by the intern.
B. Philosophy Statements: Please note that this is your opportunity to
demonstrate your professional writing competence. Check for appropriate
grammar, spelling, and cohesion of thought. Please cite any references to
outside material or information using APA format.
National Roster Internship Application, revised 1/2028, AIAC Committee Page 4
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
What is the philosophy of your music therapy program? In your own words,
discuss your views about how and why music is effective as a therapeutic modality.
Include your beliefs regarding the value of music in your personal music therapy
approach to client treatment, clinical techniques, uses of music, and/or theoretical
models. Describe how you, as a therapist, determine client needs/goals/ objectives
during the planning and implementation phases of treatment. How do you perceive
the role of the client during sessions? Describe the nature of music and the role that
it plays in your personal treatment style. Mention specific theoretical frameworks
and describe how and why those models are used/integrated into your clinical
practice. How do these theories and frameworks shape your own clinical
interactions?
What is your philosophy regarding training interns? In your own words,
describe your beliefs about how interns effectively learn skills in clinical practice.
Include statements regarding your style and approach, the methods of training you
intend to employ, what you consider to be the most important aspects of a
successful internship experience. What is the role of music in your philosophy of
intern training? How would or could you use music to develop your intern’s music
skills, interactions skills, leadership skills, and other skills included in the AMTA
Professional Competencies? Write three (3) sample goals with corresponding
objectives. Indicate three (3) AMTA Professional Competencies and write one goal
for each competence. Write a corresponding objective related to intern skill
development for each goal. Please cite the AMTA Professional Competence used to
formulate the goal. State the philosophical basis for how you would address the skill
development of the intern through the use of such goals and objectives.Include
information about how supervising music therapists will accommodate intern
development.
C. A series of three (3) sample internship schedules – one from Week 6 of the
internship, one from week 13 of the internship, and the last from Week 22 of
the internship. Place this schedule into a weekly calendar format. Include the
following elements:
• the number of hours of music therapy treatment groups (opportunities
for the student to observe, co-lead, and/or lead sessions);
• documentation, office time to work on projects or session planning;
• team meetings, in-services;
• observation and supervision time;
• and when an MT-BC will be directly observing the intern in music
therapy sessions – indicate this by placing “MT-BC observing intern”
on the schedule.
D. Copies of internship forms developed for your site, including:
1. Application for internship - Be sure to include the following:
• contact information – indicate your contact information at the top
of the page;
• administrative requirements – ensure that this matches the
information presented on the fact sheet;
National Roster Internship Application, revised 1/2028, AIAC Committee Page 5
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
• legal affiliation information – ensure that this matches the
information presented on the fact sheet;
• requirement for letter of verification from the academic director;
• contact information for the academic director;
• and other pertinent information for use during the internship
process
Be sure not to ask for information that is inappropriate or illegal – review
with Human Resources professionals if unsure.)
2. Orientation Checklist - Be sure to include the following:
• necessary AMTA Professional Documents as outlined in the
National Roster Internship Guidelines;
• contact information of your regional AIAC representative in the
checklist;
• any trainings required by the facility;
• all administrative requirements as outlined on your fact sheet and
application;
• completion of the internship agreement;
• completion of legal affiliation agreement (if needed)
3. Competency-Specific Intern Evaluation Form/Intern Self-
Evaluation Form (Midterm and Final) This form must include
reference to expected level of performance in all areas of the AMTA
Professional Competencies. Include the following:
• a list of ALL the AMTA Professional Competencies – indicate if you
will NOT be addressing or evaluating the competence next to each
competence
• Indication of person completing the form – intern, supervising
music therapist, and internship director
• Indication of when the form is completed – mid-term or final
• Prompt to send the completed form to the academic director of the
intern’s educational program
• Signature lines for all reviewers – intern, supervising music
therapist (if relevant), and internship director
4. Site evaluation form – Include the following:
• Name of the facility listed at top of the document;
• a statement at the end of the document that copies of the
completed form will be provided to the intern, academic advisor
and regional AIAC representative;
• place for internship director to write in responses to any issues
indicated on the evaluation;
• Signature lines for intern and internship director
If using form provided in handbook, ensure that the original author is
indicated.
5. Intern Dismissal Policy and Procedure Document – Include the
following:
• Use the word “dismissal” throughout – not “termination.”
• Name of the facility listed at the top of the document;
• Facility policies and procedures that interns will be expected to
follow;
National Roster Internship Application, revised 1/2028, AIAC Committee Page 6
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
• AMTA and CBMT statements, standards, codes, etc. that interns will
be expected to follow;
• Procedures for remediation of skills or issues that occur – include
the academic director in these procedures
• Events that would merit immediate dismissal
• Notification of the AIAC representative that the intern is having
difficulties and/or has been dismissed;
• the intern's acknowledgment of the policy;
• Internship Director’s review of the policy and procedure with the
intern;
• Signature and date lines for intern and internship director
E. A formal resume/vita for the Internship Director and each supervising music
therapist, indicating education, internship experience, and work history.
F. Letters of support/recommendation, including:
A letter of support for the internship program from the facility
administrator/CEO bearing an original signature (letters may be scanned and
sent via electronic means, if desired)
Two (2) letters of recommendation for the Internship Director bearing
original signatures (letters may be scanned and sent via electronic means, if
desired) that reflect professional clinical skills, supervisory skills, professional
qualities and characteristics, and verbal and written communication skills. It
is strongly recommended/encouraged that one letter come from another
music therapist or music therapy educator. These letters may not be written
by a music therapist who is part of the application/proposed internship
program.
G. Documentation of minimum of 5-hour formal training in supervisory
processes and techniques within 5 years prior to application to become
Internship Director: (e.g., certificate of completed supervision CMTE course
offered at regional and national AMTA conferences, transcripts from graduate
course, or other related supervisory training course). If coursework is not
offered by the Association Internship Approval Committee, please indicate the
instructor of the course, the dates, and a course outline to assist reviewers in
determining relevance to internship training.
National Roster Internship Application, revised 1/2028, AIAC Committee Page 7
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
Responsibilities of the Internship Director
(Compiled from the AMTA National Roster Internship Guidelines (Revised 2018).
1. Structure, implement, plan, and monitor internship program in accordance with
the AMTA National Roster Internship Guidelines.
2. Respond to student requests for information and applications.
3. Review applications, select music therapy interns and communicate with
students.
A. Notify the applicant’s academic faculty, in writing, that the applicant has
accepted the internship, when it will begin, target date for formulating the
internship agreement, status of the legal affiliation agreement, and all other
site requirements as applicable.
B. Send a copy of this letter to the Association Internship Approval Committee
Regional Representative (AIAC Rep).
4. In partnership with the academic faculty, develop an internship agreement
based on the needs and abilities of each intern, including types of/numbers of
music therapy groups, documentation, special projects, etc. and assign
supervisory responsibilities to qualified music therapy staff. (NOTE: Other
professional staff may provide support in the training process which are not
specifically related to music therapy skills).
5. Provide the intern with a thorough orientation, including facility tour, review of
AMTA documents (i.e.: Standards of Practice, Organizational Structure, Code of
Ethics, National Roster Internship Guidelines, and the AMTA Professional
Competencies), the CBMT Code of Professional Practice, applicable policies and
procedures of the site, and Intern Dismissal Policies and Procedures.
6. Provide viable music therapy role model(s) for interns either personally or
through other qualified music therapists on staff (leading music therapy sessions
which the interns can observe or co-lead).
7. Provide at least one (1) hour of supervision per week for the intern (adjust
accordingly for part time schedules).
8. Provide for at least four (4) hours of observation (formal and informal) and
constructive feedback per week for the intern (adjust accordingly for part time
schedules).
9. Establish and coordinate a network of supportive professional contacts.
10.Communicate information to the intern regarding ongoing seminars,
conferences, workshops, and community resources.
11.Complete and review midterm and final evaluations with the music therapy
intern; provide copies of all evaluations to the intern and the intern's academic
site.
12.Provide the intern with a site evaluation to be completed at the end of the
internship.
A. Review the site evaluation with the intern. (This review should occur after the
intern's final evaluation has been discussed and should be used to help
identify areas for improvement in the site.)
B. Provide copies of the intern-completed site evaluation to the intern, academic
advisor and AIAC Rep.
National Roster Internship Application, revised 1/2028, AIAC Committee Page 8
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
13.Maintain continuous communication with the intern and his/her academic faculty
regarding all aspects of the internship process including all site-specific
requirements and the intern’s progress.
14.Initiate performance improvement plans with the intern and academic faculty,
when necessary.
15.Accept no more than two interns per full time supervising music therapy staff at
any given time.
16.Accept interns no more than a year in advance of the internship start date.
17.Upon request of the intern, provide a letter of verification documenting
successful completion of internship.
18.Notify the national office and AIAC Representative of any significant changes
within the established National Roster Internship.
19.Adhere to the National Roster Internship Guidelines and initiate exception
requests as needed.
20.Monitor and act on any non-compliance issues that may arise.
21.Follow established policy and procedure regarding dismissal of interns.
22.Pursue opportunities for continuing education in the area of clinical training and
supervision.
23.Submit an annual report to your AIAC Regional Representative.
24.Maintain communication with your AIAC Regional Representative.
I understand and accept the above-stated responsibilities of the role of
the Internship Director.
Name:
Facility Name:
Date:
(Submitting an application via email implies electronic signature by the applicant.)
National Roster Internship Application, revised 1/2028, AIAC Committee Page 9
8455 Colesville Rd. Suite 1000 | Silver Spring, MD 20910, USA | 301-589-3300 | www.musictherapy.org
Responsibilities of the Supervising Music Therapist
(Compiled from the AMTA National Roster Internship Guidelines (Revised 2018).
• Serve as a viable music therapy role model for interns.
• Serve as a virtuous role model in adherence to the AMTA Code of Ethics.
• Maintain an appropriate professional credential or designation in music
therapy (e.g., MT-BC, RMT, CMT)
• Provide supervisory responsibilities to music therapy interns as assigned by
the internship director.
• Monitor and act on any non-compliance and ethical issues that may arise
• Pursue continuing education relevant to his/her clinical and supervisory
responsibilities.
• Maintain professional membership with AMTA with the exception of graduate
student members of AMTA meeting all other requirements.
• Lead and co-lead music therapy sessions that the intern can observe.
• Assist interns with learning all aspect of clinical work as required by facility
(e.g., documentation, team meetings, and treatment planning).
• Provide an average of four hours per week of formal and informal
observation and constructive feedback of assigned intern.
• Be readily available and provide additional assistance to intern as needed.
• Provide a minimum of one hour per week of individual supervision with each
assigned intern if applicable.
• For internship programs structured at less than 40 hours per week, the hours
for supervision, consultation and observation should be adjusted accordingly
(for example 30 minutes of weekly consultation per 20 hours per week).
• Communicate information to the intern regarding ongoing seminars,
conferences, workshops, and community resources.
• Maintain regular communication with Internship Director and other
professional staff involved in the training of the intern.
• Complete midterm and final evaluation of assigned intern(s) and submit to
internship director for review.
I understand and accept the above-stated responsibilities of the role of the
supervising music therapist.
Name:
Facility Name:
Date:
Internship Director:
(Submitting an application via email implies electronic signature by the applicant.)
