Barnes Center at The Arch Bulk Sexual Health Supplies

Thank you for your interest in bulk sexual health supplies please fill out our form to request supplies. Once your request has been processed, you will receive an email letting you know that your items are ready for pick-up at Health Promotion in the Barnes Center at The Arch. Please allow us 5 business days to prepare your supplies. Please Note: This form is for student leaders, staff and faculty that will be distributing supplies. If you would like supplies for personal use please fill out the Safer Sex Express form.

Name Name First Last
Email (Please use your Syracuse email)
Title/Role?
Please select the box below that best describes your role

Please select the box below that best describes your role Student Leader Graduate Assistant Teaching Assistant Academic Advisor Staff Faculty Other Other
Date needed (Please note that all requests require at least one week of lead time.) Date needed (Please note that all requests require at least one week of lead time.) / MM / DD YYYY
Quantity of external condoms requested
Must be a number less than or equal to 250.
Quantity of internal condoms requested?
Must be a number less than or equal to 24.
Quantity of personal lubricant requested
Must be a number less than or equal to 250.
Quantity of oral dams requested
Must be a number less than or equal to 24.
Please describe how you will be distributing the bulk sexual health supplies. (Be as descriptive about how you will be distributing the supplies including details on programming if applicable!)
Request description, comments, or additional notes
How did you hear about the bulk sexual health supply order form?
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