Safe Sex Kit Request

This form allows the Community Health Education and Resiliency Program to take and keep track of requests for Safer Sex Supplies. If you'd like us to mail you supplies, please fill out the below form in its entirety. The demographic info helps us with our grant funding, so the more information the better.
If you have any questions, please feel free to contact:

Savannah Gene, Program Director (She/Her/Hers)
Kurt Begaye, Senior Capacity Building Specialist (He/Him/His)