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Learn to Read Comics Application Form
Application for Materials Donation
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* Indicates required question
Email
*
Your email
Name of Organization
*
Your answer
Address
*
Your answer
City, State, Zip Code
*
Your answer
Country
*
Your answer
Primary Contact
*
Your answer
Position
*
Your answer
Email Address
*
Your answer
Website Address
*
Your answer
Phone Number
*
Your answer
Number of Students Learning to Read English
*
Your answer
Number of English Teachers
*
Your answer
Number of Art Students (interested in drawing)
*
Your answer
Number of Art Teachers
*
Your answer
Student Age Range
*
Your answer
Access to Internet?
*
Yes
No
Best Way to Send/Ship Materials to you?
*
Your answer
Would you be willing to share photos of your organization's students using the product donated?
*
If yes, please provide photos in full high resolution files, if possible, so we can share on all media related outlets.
Yes
No
Maybe
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