SHE Project, Inc. Self Love Sexual Health Kit
Thank you for signing up to receive your free sexual health kit. We will reach out to you in 48 hours to confirm your mailing address to send the kit and answer any questions. Our staff is available to answer questions, link to you to services and to be of support.  All responses will be kept confidential and will not be shared with anyone outside of our staff. 

In order to receive a kit in this program:
  • You must be HIV -.
  • Live in the state of Mississippi
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Email *
Name *
Email *
Phone Number
Mailing Address(this is where we will send your kit) 
Street Number, Street Name, City, State and Zip Code are required
*
Do you currently LIVE in the state of Mississippi? *
If you do not live in the state of Mississippi you would not qualify for this program. You can end the survey at this time.
Age *
Year of Birth *
Race
Gender *
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