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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. 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 thewell@ucr,edu

If you have any questions, please email thewell@ucr.edu or call 951-827-9355.

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

Thank you!

Name *
Your answer
Email *
Your answer
Location of Event *
Your answer
How many people do you anticipate at your event? *
Your answer
How many condoms are you requesting? (we cannot provide more than 50 condoms)
Your answer
By what date will you need to pick up the materials? (note we require at least a 48-hour notice) *
Your answer
Describe your event *
Your answer
All events are required to have an educational component. Describe the educational component(s) your event will have. *
Your answer
How will you promote The WELL or other health and wellness organizations during your event *
Your answer
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