Safer Sex Supply Requests
FREE Safer Sex Supplies are provided by the Health Promotion and Wellness Services (HPWS) unit at the University Health Center (UHC). 

This form is for current students and faculty/staff at the University of Maryland College Park to request* free: 
  1. Bulk pack of supplies for distribution to other students (e.g., RA programs, student group meetings, office spaces, events, etc.)
    OR 
  2. Specific individual supplies for personal use that may be harder to come by (e.g. non-latex condoms, oral dams).
*Limit is 2 requests per month

SPRING 2024 UPDATE: We've seen an increase in demand and want to ensure all free supplies are meaningfully distributed. This means that not all bulk requests will be filled. You may be asked to share your distribution plan, program proposal, and marketing flyer as part of your bulk request.

If you have questions or requests that can't be met through this form, email Sexual Health Program Assistant Coordinator Miriam Levitin at miriam64@umd.edu.

You will receive a copy of your responses to the email address that you provide below. We will use that email address to contact you about picking up your request and possibly for future evaluation of our services. Please double check to make sure you typed your email correctly!
Sign in to Google to save your progress. Learn more
Email *
What is your first name? *
What is your last name? *
How did you hear about this program? *
Required
Are you: *
If you are both a student and employee, please select the role that best represents your reason for requesting (e.g., a staff member making a bulk pack available for students; a student making an individual request) 
Are you requesting as a: *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Maryland, College Park. Report Abuse