Request Assistance Application

Please ensure you have enough time to complete and submit this application — with required documentation — in one sitting, as it does not “save as you go”.

Contact Us

  • MM slash DD slash YYYY
  • The MHA Team will be back in touch within 48 hours, hopefully sooner. Please be patient during this season of health crisis.
    If you answered YES above, who is your advocate? Please select the advocate that you have worked with previously at Music Health Alliance.
  • This field is for validation purposes and should be left unchanged.