The Coulee Region Music Festival was founded in 1960 by a board that included Francesco "Frank" Italiano, the conductor of the Coulee Region Symphony Orchestra. Italiano started his musical career as a high school band director at Cashton, Wisconsin, in the 1930s and moved to La Crosse to direct the Logan High School Band in 1946. He also directed the Onalaska Luther High School Band and from 1968 to 1972 directed the La Crosse Symphony. To help develop talented musicians for the La Crosse Symphony, he founded the La Crosse Youth Symphony program in 1969. It was his dream to establish both a summer symphony program and a youth symphony that led to him founding The Symphony School of America. The school began as a three-week program designed to prepare students to perform in the finale of the Coulee Region Symphony at the Coulee Land Music Festival. The Coulee Region Symphony was the main performer at the festival and had a variety of performances such as "Music Under the Stars." The symphony was made up of musicians mainly from La Crosse and nearby cites of Wisconsin and Minnesota. Frank Italiano saw the school and festival as connecting to the "Wisconsin Idea" of extending quality music experience to areas that otherwise would not have such music available to them.

Apparently, there was an immediate interest to broaden the effort to include other arts, so the following year, 1961, the festival was renamed as the Coulee Region Arts Festival. Raymond C. Plamadore was general chairman of the Coulee Region Arts Festival Executive Committee and it 1962 consisted of 11 subcommittees. There was an art exhibition, a film program, a youth symphony, a youth symphony school (the Symphony School of America) and a music clinic. The Coulee Region Symphony was the centerpiece and offered a week of concerts in late July. Symphony school students would work with expert artists from across the nation to build their skill to perform in The Coulee Region Symphony.

The Symphony School of America was officially founded in 1961 on the foundations of the Coulee Region Symphony program from the previous year. The school started by providing symphony workshops for students. It expanded annually, so that by 1964 it included approximately 58 students, a private concert, a master piano class and professional voice coaching. High school and college students and adult musicians learned together. The group was housed in the dormitories at UW-La Crosse and gave six concerts and up to five recitals during its season. The participants were also able to earn up to three college credits in orchestra performance, applied instrumental performance and ensemble performance.

In 1966 an expansion of the Symphony School led to a residency for two weeks at Dodgeville for the students and their faculty of professional musicians. During this time, they became The Symphony of the Hills and performed at Governor Dodge State Park. They then moved for a second residency of three weeks in La Crosse, where the musicians performed as the Coulee Region Symphony. In both settings, the students and their instructors performed side-by-side. Each year there was a residency of a musician from a major orchestra to enrich students and faculty alike.

Small subgroups of the SSA were formed: a German band, a jazz combo and a faculty chamber group. In 1979, for instance, the chamber music group performed in Ashland & Superior, Wisconsin, and Winona, Minnesota. In 1972, there were three locations for residencies and concerts: Two weeks at Dodgeville as The Symphony of the Hills, one week at Shell Lake as the Indianhead Symphony and then two weeks at La Crosse at which time this symphony was renamed “The Great River Symphony.” By 1975 there was sufficient support to establish a youth symphony just in La Crosse. Due to financial difficulties in 1983 the Symphony School of America moved to Superior for the two-and a half-week period instead of La Crosse due to it being cheaper to stay at UW Superior.

Parallel to the growth of the musical efforts was a renaming of the entire festival to become the Coulee Region Arts Festival and then the Coulee Region Festival of Arts, the last name becoming the one that was used until 1976 when it became the Great River Festival of Arts. The Great River Festival of the Art would eventually develop into becoming the Great River Folk Festival which still operates.

In 1984, after a disagreement between the symphony board and the festival board, the Symphony School was moved and thus headquartered for the summer program at Superior and Dodgeville. Nevertheless, the concerts continued in La Crosse during the Great River Festival of Arts. The Symphony of the Hills and the Symphony School of America ended in 1987 after lack of funds no longer made it possible to support the $125,000 budget.