PPMW PROJECT REGISTRATION

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``udents in need with menstrual products so you can stay focused on what matters most. Once you register, you will receive a month’s supply of product during the months you are in school: pads, tampons, wipes, free menstrual education pamphlets, and information about our health centers and our services. Please visit ppmwproject.org for more information.

Today's Date *

YYYY

School Email *

First Name *

Last Name *

Phone Number *

Date of Birth *

YYYY

Race/Ethnicity

Asian American/ Pacific Islander/ Hawaiian

African America/ Black/ African/ Caribbean

Latino/ Latinx

Middle Eastern/ North African

Native American/ Alaskan Native

White

Prefer not to disclose

Other:

Preferred Pronouns/Gender Identity

she/her/her

he/him/his

they/them/theirs

my gender identity is not reflected here

prefer not to say

Other:

Expected Graduation Year *

Class of 2024

Class of 2025

Class of 2026

Class of 2027

Other:

What school do you Attend? *

Montgomery College

Howard University

Other:

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