imPrint Collective Therapy Initiative- New York (Application form)
Hello!
This application form is for people who are in need of therapy care and cannot afford it on their own. This initiative is also intentionally seeking to serve members of the Black LGBTQA community. We ask that if you do not self identify with any of the statements above that you yourself not apply, but rather send it to a friends whom you know is in need, or please donate.

If you do identify with the above statements; this is a random process, there are no favorites, and the draw is randomized. The application form is a formality to make sure that those whom this initiative are meant to serve are reached.

We hope this is finding you well!

Team Mag is working in collaboration with Ms. Giitou Neor, a Black clinician committed to working with POC around managing their mental health need, connecting to necessary resource, and providing support, will be providing free Mental Health check-up for one year to a community member based in New York.
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Email *
Name *
Do you identify as Black? *
Do you identify as queer? *
Do you live in the City of New York? *
Zip Code *
Any additional info you'd like to share?
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