Music Therapy Assessment Name of Client: ________________Date of Birth:_____________Date(s) of Assessment:____________ School and District: _________________ General Information: Assessment

Referral: As per the request of the IEP team of P.S. 48x a music therapy assessment was authorized to be completed on (students name). Assessment Procedures: The music therapist at P.S. 48 uses a criterion-references Music Therapy assessment process as outlined in the SEMTAP (the Coleman/Brunk Special Education Music Therapy Assessment Process). Assessment is by therapist observation with additional information supplied by treatment team members. Assessment Criteria: The following assessment criteria were selected from (childs name) current IEP and included goal areas that were able to be observed during the assessment period that are also typical of music therapy goal areas. Assessment: General Observations: Cognitive Functions: Communication: Social/Emotional/Behavioral Function: Sensory/Motor Function: Summary: Filled Out By:_____________