APPLY Apply for our program First Name * Last Name * Street Address * City, State, Zip * Phone * Email * Emergency contact number * Emergency contact name * Have you been diagnosed with * PTSD Depression Instrument choice * Rhythm Guitar Lead Guitar Bass Guitar Lap Steel Favorite music style (select all you like) Rock Country Bluegrass Jazz Folk Prog Rock Metal On a scale of 1 to 10 how does PTSD affect your daily life? * 1 2 3 4 5 6 7 8 9 10 On a scale of 1 to 10 how does depression affect your daily life? * 1 2 3 4 5 6 7 8 9 10 If approved for this program can you guarantee 30 minutes per day to practice? * Yes No Any physical limitations that may affect you in this program? What do you hope to gain from your participation in this program? Lesson Location preferences (select all you'd be willing to travel to) * Millsboro, De Dover, DE Federalsburg, MD Salisbury, MD Submit If you are human, leave this field blank.