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The WELL Condom Request Form
To educate our students and promote better health, The WELL offers Condom Co-Op and The Jolly Trolley, where students can pick up free safer sex supplies. We are happy to provide these services for individuals on a walk-in basis in HUB 248, but we require that student groups, RAs, and others who are seeking safer sex supplies in larger quantities complete this survey in advance of picking up their order. If approved, we will prepare your supplies for pickup the following day. Please note that we do not accept requests for specific types, styles or brands of condoms for bulk requests, and that bulk requests are fulfilled using our surplus inventory.

The WELL is also home to Golden ARCHES Peer Health Educators, who are will come to your group to present a workshop or lead activities to promote sexual health, education and empowerment. Please submit all program requests to thewellevents@gmail.com.

If you have any questions, please email thewellevents@gmail.com or call 951-827-9355.

For more information about The WELL and our programs and services, please visit well.ucr.edu.

Thank you!

Your name *
Your answer
Your email *
Your answer
Name of your group, event, res hall, etc. *
Your answer
Number of program participants/number of condoms requested *
Your answer
Date of program/pickup date (Please note: We require 48 business hours advance notice to approve requests) *
Your answer
Please describe the program where you'll be distributing safer sex supplies. *
Your answer
How do you plan on educating your members or residents on safer sex practices? *
Your answer
How do you plan on promoting The WELL and the services we provide? *
Your answer
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