Sexual Health Supplies Request Form
After submitting your request, please allow up to 24 hours for your order to be completed. Orders submitted over the weekend will be completed on the next business day. Completed orders may be picked up in the office of Health Promotion and Wellness Monday - Friday between the hours of 9:00am and 5:00pm. If you have any questions, please contact us at
*Please note, depending on availability, packaging may vary from pictures.
Name (First and Last):
Student Id #
Condoms (Select option Below)
Regular External (Male Condom) Check
Non-latex External Condom ( for latex allergy sensitivity)
XL External Condom
Internal Condom (aka Female Condom)
Flavored External Condom
"Studded" Latex Condom
Sexual Health Supplies
Water Based Lubricant
Please indicate below if you would like to speak to a health educator regarding any sexual health concerns or questions.
Yes, I would like to speak to a health educator.
No, I do not need to speak to a health educator.
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