Student Organization/Event Safer Sex Supply Request Form

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This form must be completed and submitted at least two weeks before your event.

Date Submitted *

Sponsoring Organization *

Contact Person in Organization *

Telephone *

Email *

WSA Account Number *

Event Title *

All activities must be in compliance with University policies and procedures governing student-run events.

Event Date *

Event Location *

Event Description *

Supplies Request: External/"Male" Condoms

Please check the quantity desired and fill in the total cost. Various brands and styles will be provided, based on current inventory.

1000 (1 case) = $66.00

500 (1/2 case) = $32.50

250 (1/4 case) = $16.25

Other = Ask for Quote

Clear selection

Supplies Request: Insertive/"Female" Condoms

Please check the quantity desired and fill in the total cost. Various brands and styles will be provided, based on current inventory.

25 pieces = $20.00

50 pieces = $40.00

Other = Ask for Quote

Clear selection

Supplies Request: Oral Dams

Please check the quantity desired and fill in the total cost. Various brands and styles will be provided, based on current inventory.

50 pieces (1/2 box) = $25.00

100 pieces (1 box) = $40.00

Other = Ask for Quote

Clear selection

Processing your request

You will hear from WesWell within one week of submitting this form. At that point we will notify you if we are able to fill your request. If you have any questions please contact WesWell at weswell@wesleyan.edu

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