Individual Safer Sex Supply Request

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Thank you for reaching out to our department!

Please complete the form below to best describe how we can support you. Safer Sex Packs are packaged individually and contain supplies specific to your request. We can provide additional sexual wellness educational materials and answer any questions you may have upon reply to your request.

All information collected will remain confidential. Address information is requested for delivery of supplies through campus mail. All safer sex supplies will be sent in an unmarked manila envelope.

First Name *

Last Name *

Email Address *

Residence Hall *

Room / Apartment Number (please include north, south, east, or west if applicable) *

Please select one of the following safer sex supplies that you would like mailed to you. *

Please select one of the following lubrication options that you would like mailed to you.

Do you have any questions regarding safer sex supplies, or do you need any resources?

Submit

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