Protection Package Order Form
We believe that all students (and individuals!) should have easy access to barrier methods, as well as sexual and reproductive health information, so that they can make informed choices in their relationships. For the same reason, we have adopted The Protection Package, a student-designed program, to deliver FREE safer sex supplies to CSUSB students!

By popular demand, you can now choose to pick up or package on campus!

Each package will have 12 barrier methods and up to 3 lubes.
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First Name *
Last Name *
Student ID *
Are you currently enrolled in classes at CSUSB? *
What is your email? Please include an email you check frequently to receive important details regarding your order. *
Are you a San Bernardino or Palm Desert campus student? *
What type of barrier method would you like to order?
**Unless otherwise specified, all barriers listed below are latex-based. If you have a latex allergy, please do not select any options that do not specify "latex-free".
 *

You can receive up to 12 types of barrier methods, if you select more than one option then it will be equally divided between the options you choose. Choose a surprise variety if you would like us to choose the barrier methods for you!

Required
Would you like to add lube to your order? (You can receive up to 3 lubes per order) *
Required
Would you like to pick up your order at the San Bernardino Campus (SB), Palm Desert Campus (PDC) or have us mail your package? *
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