PLEASE READ BELOW BEFORE FILLING OUT THIS FORM
Please abide by the Wellesley Honor Code and fill out this form ONLY if one or more of the following apply to you:
1. Immunocompromised
2. Low-income
3. Positive for COVID-19 or at risk due to close contact
4. Currently have no KF94 or KN95 masks and unable to purchase
We can provide 1 pack (5 masks per pack) per individual per 2 weeks. Please be mindful of others and do not request more masks beyond this limit since we have a limited supply. To properly use your KF94 masks, please refer to this
Mask Care and Reuse Guide.
All information you provide on this form will remain confidential. The purpose of this form is to keep track of the number of masks we distribute and to make sure that not one person exceeds the maximum limit for requesting masks.
After filling out this form, you can pick up 1 pack of masks from the College Club testing site, where you need to scan a QR code and fill out the short pick-up form to indicate that you have taken your mask pack. After hitting submit on this form, you will see a message that includes the password for the pick-up form.
Please contact wellesleysvp@gmail.com if you have any questions or concerns. We hope to be of help and a source of strength for our Wellesley community! We always wish you the best of health and well-being.
