Financial Coaching Request Form

MusiCares' support is intended to provide a safety net as music professionals navigate unforeseen events and to prevent them from incurring catastrophic financial debt as a result. Please explain why you are interested in financial coaching

MusiCares is offering 1:1 Financial Coaching to eligible individuals. Coaching entails individuals sessions with a certified financial coach to identify and execute a targeted financial goals. Music industry professionals with documentation of at least five (5) years paid industry work or credits on at least six (6) commercially released tracks or videos are eligible for this program.

Please ensure requested documents are uploaded and all questions are answered.

Required documentation includes:

1. Proof of Music Industry Work: MusiCares requires proof of at least 5 years nonconsecutive paid work in the music industry OR 6 commercially released credits. Credits can be streaming/distributed on paid sites and/or registered with entities such as BMI or ASCAP. Accepted documentation must clearly note legal name.

Please choose ONE of the following options:

Option 1: 5 Years Paid Music Industry Experience:

Resume/discography
Accepted forms of documentation include at least 2 of the following documenting *5 years:

W-2's
1099 Forms
Signed contracts with corresponding proof of payment (canceled checks, bank statements noting deposits)
Paycheck stubs

*Documentation of 5 years does not need to be consecutive.

Option 2: Commercially Released Credits:

Resume/discography
Accepted forms of documentation include at least 1 of the following:

PROs statements that clearly note 6 commercially released recordings (such as ASCAP or BMI)
Distribution statements (such as DistroKid, TuneCore)
Royalty statements from paid streaming platforms (such as Apple Music, Spotify, Tidal, Amazon Music)

*All statements must clearly note your legal name.

General Information

First Name

Last Name

Home Address or Mailing Address Line 1:

Address Line 2:

City:

State

Zip/Postal Code

Primary phone number

Email

Date of Birth

Do you have dependents?

YesNo

How many?

Ages of Dependents:

Demographic Information

Inclusivity is a primary value at MusiCares and we aim to serve all music professions, genres, races, genders, ages, disabilities, and more. Sharing this information helps us to better know the makeup of our client base and if we are achieving our goals to serve all in music.

Gender

Pronouns

Race (for statistical purposes only, optional)

Have you received prior MusiCares financial assistance?

Have you applied or received MusiCares assistance in the past 12 months?

YesNo

Medical Information

Are you currently receiving treatment for any medical issues that impact your finances

YesNo

Please describe

Do you have health insurance?

MedicaidMedicareCommercial InsuranceNone

Do you have dental insurance?

YesNo

Housing

Number of people in your household:

Monthly rent/mortgage amount:

$

Have you and/or are you currently receiving any other financial assistance from another organization(s)?

YesNo

When?

Monthly Budget Form

Average Monthly Income from Music Industry Work:

$

Average Monthly Income from non-Music Industry Work:

$

Residuals and Royalties

$

Unemployment

$

Social Security Income

$

Social Security Disability

$

SSI (Supplemental Sec.) General Relief

$

Food Stamps

$

Veterans Benefits

$

Spouse/Partner’s Income

$

Alimony

$

Child Support

$

Union Pension(s)

$

Expenses

Home Insurance

$

Food/Groceries

$

Utilities:

Gas

$

Electric

$

Water

$

Cell Phone/Telephone

$

Cable/Internet

$

Transportation:

Car Payment

$

Car Insurance

$

Public Transit

$

Medical & Dental:

Health Insurance

$

Medical Bills

$

Dental Bills

$

Miscellaneous:

Life Insurance

$

Loan(s)

$

Average Total Monthly Credit Card Payment(s)

$

Child Support

$

Alimony

$

Other

$

The following questions pertain to how you experience your financial wellness. Your answers will help us better understand factors contributing to financial health and the music industry.

HIPAA

I understand that my Health Information that is disclosed pursuant to this Authorization may be re-disclosed by the recipient of that information and may no longer be protected by the Health Insurance Portability and Accountability Act (HIPAA) or other applicable privacy or health privacy laws. Except as expressly stated in this Authorization, nothing in these acknowledgements or this Authorization shall be considered as a waiver of any rights to privacy or nondisclosure of information that I may otherwise have under any applicable law.

I agree

ASSISTANCE LIMITATIONS

When financial assistance is provided by MusiCares, it is charitable in nature and therefore, before seeking such assistance, applicants are required to investigate all other possible sources of aid. All approved assistance is paid directly to a creditor/third party. At its sole discretion, MusiCares reserves the right to deny or approve financial assistance. MusiCares shall deny, revoke, or terminate grants when there is evidence of a client's negligence, recklessness, or abuse of aid.

I agree

Thank you for your interest.

Be sure to check your email with directions to confirm your form submission. MusiCares will be in contact with next steps.

Alternative	American Roots
Children's	Classical
Comedy	Contemporary Instrumental
Country	Dance Electronic
Film_TV_Media	Gospel Christian
Hip Hop	Jazz
Latin	Musical_Theater
New_Age	Pop
R&B	Rap
Reggae	Rock
Spoken_Word (Poets Narrators, Comedians)	World
Other