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Anime Therapy Kit Grant

Thank you so much for helping us bring the Anime Therapy Kits to more people. Getting an Anime Therapy Kit in someone’s hands means we’ve given them the tools and the hope to take a step in a positive direction.
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1
Primary Contact Name
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2
Primary Contact's Pronouns
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3
Primary Contact's Email
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4
Primary Contact Phone
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5
Tell us about you
  • A Library
  • B Therapist
  • C Event/Convention
  • D Anime/Culture Club
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6
Event/Convention Name
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7
Event/Convention Location
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8
Event/Convention Website
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9
Approx Number of Attendees
  • A <2500
  • B 5000
  • C 10,000
  • D Other
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10
Library Branch Name
(No acronyms or abbreviations)
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11
Do you run an anime/culture club at your branch?
  • A Yes
  • B No
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12
School Name
(No acronyms or abbreviations)
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13
Tell us about your Club
How many attendees? Age group? How often you meet? what sort of activities you do?
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14
Are you interested to join the Anime For Humanity Ambassador Club?
To learn more visit: https://animeforhumanity.org/club/
  • A Yes
  • B No
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15
How familiar are you with anime?
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
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16
Do you use anime in your practice?
  • A Yes
  • B No
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17
Would you want to be added to our searchable database of therapists?
We get a ton of requests from attendees to find and work with therapists with a background in anime.
  • A Yes
  • B No
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18
Licensure status in psychology or related field? (psychology, counseling, social work, psychiatry, etc.)
  • A Independently licensed
  • B Pre-licensed, associate level, postdoctoral
  • C Other
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19
If you hold licensure for independent practice, what is your license number, and in what state is it held? We use this to verify licensure status. Otherwise, enter "n/a" below.

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20
What is Your Website?
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21
How many Anime Therapy Kits you need?
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22
Shipping Address
Please provide your full postal address (Address, City, Zip)
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23
Optional: would you like to cover the costs of shipping?
$10 per 25 Anime Therapy Kits
  • A Yes
  • B No
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24
Any additional comment?
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Arigatou Gozaimasu!

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