Risk Reduction Resource Kit Request Form
Health Initiatives for Youth (HIFY) is excited to distribute FREE Risk Reduction Resource Kits (RRRKs) to various youth service providers in San Francisco and Oakland! A RRRK includes a variety of supplies and information around reproductive health and substance use. In an effort to broaden our work around harm reduction, we hope to distribute the kits to various youth serving providers who will in turn help increase the access to information and supplies to more youth.
What is included in a RRRK:
• Female Contraceptive Model
• Male Contraceptive Model
• External & Internal Condoms **
• Dental Dams **
• Lube **
• Pregnancy Tests **
• Birth Control Pill Pack Model
• Emergency Contraceptive Pill Box Model
• Contraceptive Ring Model
• IUD Insertion Device Model
• IUD Model
• Contraceptive Implant Model
• Drug Information Cards (postcard-sized, contain comprehensive drug info) **
• Coffee table books (geared toward queer & trans youth, positive sexuality, and bodies & diversity)
• Posters for the organization/site
• Rapid HIV Test
• Resource Brochure on free/low cost local youth clinics in SF Bay Area
• Sexual Health Brochures
• Substance Use/Harm Reduction Brochures
** These items qualify for FREE refills.
Do I qualify to receive a RRRK?
- Must serve under-resourced middle or high school youth
- Must be able to place kit in a location where youth can access it independently
- Must have a point-of-contact for youth requesting the Rapid HIV Test (included in the kit)
If your organization, agency, or school meets the requirements described above,
you can request a FREE kit from HIFY by completing the following form.
For more information about Health Initiatives for Youth and our work, please visit our website at
www.hi4youth.org
.
* Required
Kit logo
Outside of kit
Kit contents (contents may vary)
Name of Organization, Agency, or School
*
Your answer
Name of Point Person
*
Your answer
Position Title of Point Person
*
Your answer
Phone Number of Point Person
*
Your answer
Email Address of Point Person
*
Your answer
How did you hear about our kits?
*
Your answer
Address of the location to which the RRRK should be delivered
*
Your answer
Number of Youth who use/pass through your space monthly?
*
Your answer
What ages or grade levels does your site support?
*
Your answer
How would this kit support your youth?
*
Your answer
Does the site have an appropriate location to place the kit? (Kits should be placed where youth can access them independently, such as in a common room or waiting area)
*
Yes
No
Other:
Where at your site would this Resource Kit be located?
*
Your answer
What are the factors contributing to the need for this material? In other words, why are these resources not already present in the space?
*
Lack of budget
Staff unsure where/how to acquire resources
Staff not fully comfortable speaking to youth about sensitive topics/this type of resource
Concerns about liability or upset parents/stakeholders
Other:
Required
Do you need everything that is included in the RRRK?
*
Yes
No
If NOT, please let us know what you DON'T need
Your answer
Comments or Questions
Your answer
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