The following document is a great place to start if you think your child could be a candidate for a music therapy assessment such as the SEMTAP.
To download a PDF of this document, please click here.
NAME: DATE OF BIRTH:
SCHOOL AND DISTRICT:
FILLED OUT BY:
This form was developed in order to aid IEP teams in determining if a student could be a candidate for a
music therapy eligibility assessment. Please consult with the teacher, parent(s), therapists and other
members of the IEP team and fill out this form based on their responses. Focus on a comparison of
behaviors and skills demonstrated during musical activities versus those demonstrated during nonmusical
activities. Please circle the appropriate response.
Does the student demonstrate a significantly increased response to music stimuli in the following skill areas?
COGNITIVE FUNCTION:
General alertness, attention yes no same don’t know
Attention to task yes no same don’t know
Ability to follow directions yes no same don’t know
Attempting difficult or disliked tasks yes no same don’t know
Comprehension of information yes no same don’t know
Sequencing tasks yes no same don’t know
Repeating patterns yes no same don’t know
COMMUNICATION:
Vocalization/verbalization yes no same don’t know
Use of gestures and/or signs yes no same don’t know
Verbalizing/singing to complete familiar phrases yes no same don’t know
Verbalizing/singing to complete phrases or sentences yes no same don’t know
Sing better than speak yes no same don’t know
Speech prosity yes no same don’t know
Vocal volume awareness and control yes no same don’t know
SOCIAL/EMOTIONAL/BEHAVIORAL FUNCTION:
Eye contact yes no same don’t know
Remaining in group yes no same don’t know
Taking turns yes no same don’t know
Attempting/completing tasks as modeled by others yes no same don’t know
In seat behaviors yes no same don’t know
Self esteem yes no same don’t know
Ability to identify emotions in self and others yes no same don’t know
Ability to process emotions of self and others yes no same don’t know
SENSORY/MOTOR FUNCTION
Grasps objects/instruments yes no same don’t know
Uses bilateral grip yes no same don’t know
Gross motor movement yes no same don’t know
Fine motor skill yes no same don’t know
Moves across midline yes no same don’t know
Visual-motor coordination yes no same don’t know
Steady, even gait yes no same don’t know
If after using this form, the IEP team determines that the student IS appropriate for a music
therapy eligibility assessment, please contact a qualified, board-certified music therapist.
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