Student Sample Kit Request Form
In order to qualify for FREE Student Sample Kits, there are two requirements. The Instructor must agree to play a short video about responsible menstrual hygiene disposal for the students and complete a short feedback survey afterward.
(Agreement on Page 2)
Name of School or School District
Phone Number (Direct Please)
Shipping Address (Please include: Street Address, City, State and Zip Code)
How many student sample kits do you need?
What date do you need the kits? (Must order at least 3 weeks in advance)
How do you prefer we contact you?
How did you hear about us?
What intrigues you the most about participating in our supplemental puberty education program?
Students should be educated about how to safely dispose of their menstrual items.
I appreciate the health benefits of the MaskIT solution.
The MaskIT solution is empowering and will help the students feel more confident.
The student sample kits are FREE!
Toilet paper is not an adequate solution for disposing menstrual items.
I appreciate the environmental benefits of the MaskIT solution.
All of the above
None of the above
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