Request Hygiene Kits (Organizations)
Is your organization serving underserved and marginalized communities in New Jersey? Is there a need for hygiene products? Please complete the form below.

Each complimentary kits include: face masks, a toothbrush, toothpaste, a bar of soap, deodorant, hand sanitizer, mouthwash, lotion, a pack of baby wipes, and sanitary napkins/tampons (upon request).
Sign in to Google to save your progress. Learn more
Organization Name *
Organization Street Address *
City *
Zip Code *
Towns Served *
Organization Website *
What is your organization's mission? *
Contact Person Title *
Contact Person First Name *
Contact Person Last Name *
Contact Person Phone Number *
Contact Person Email
*
Please describe when these hygiene kits will be distributed and who will receive them *
Approximately how many people does your organization serve on a monthly basis? *
Is your organization in need of sanitary pads/tampons? *
* I understand that Hope for Health & Hygiene has the capacity of providing 50 hygiene kits to my organization. *
 * I understand that Hope for Health & Hygiene cannot deliver kits at this time, my organization will be responsible for picking up the hygiene kits from Plainfield, New Jersey. *
How did you learn of Hope for Health & Hygiene? *
Is there anything you'd like us to know? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy