Diva Cup Application Form

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If you are interested in receiving a Diva Cup, please fill out this form by February 15th, 5:00 PM.

If your application is approved, you must be available February 16th, 6:30-7:30 PM to attend an informational meeting about safe menstrual cup usage.

If you have any questions, please contact us at erc@asi.sfsu.edu

Name (First, Last): *

School ID #: *

School Email: *

Preferred Size 1: *

Model 0 - For ages 18 and under.

Model 1 - For between the ages of 19 and 30 and have a medium menstrual flow.

Model 2 - For age of 30 and/or have a heavier menstrual flow.

Preferred Size 2: *

Model 0 - For ages 18 and under.

Model 1 - For between the ages of 19 and 30 and have a medium menstrual flow.

Model 2 - For age of 30 and/or have a heavier menstrual flow.

Are you available to attend our informational meeting February 16th, 6:30 - 7:30 PM? *

Yes

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