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The NCSD-TrojanTM Brand Condoms partnership was born in 2014 in order to connect NCSD member health departments with condom resources. Church & Dwight, the parent company of TrojanTM Brand Condoms, leverages its resources in collaboration with NCSD to donate one million condoms every year to programs and partners across the nation. 
 
Please fill out this form to receive a donation of TrojanTM Brand Condoms. This application will close on January 31, 2023.

If you have any questions about this program, please email Talia Parker (tparker@ncsddc.org).

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* 1. Name of Organization/Agency

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* 2. Contact Name

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* 3. Contact Email

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* 4. Contact Phone Number

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* 5. Type of Organization

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* 6. NCSD Membership

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* 7. Please share the shipping information for the person and place specifically responsible for receiving deliveries and storage. It is imperative that NCSD and the shipping company can verify and reach out to coordinate a delivery. Please note, at this time Trojan cannot ship to PO boxes.

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* 8. Please describe the location of your storage site.

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* 9. Does your storage site have a loading dock?

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* 10. What populations do you primarily serve? (check all that apply)

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* 11. How many condoms would you like to receive? (condoms come in increments of 1000)

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* 12. NCSD will be using the latest CDC-published surveillance data to look at STD morbidity in your state or county. Please describe local factors that we should consider in selecting your site for this donation. 

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* 13. How did you hear about Condom Connect? (select all that apply)

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* 14. Are you currently receiving Trojan Brand Condoms at discounted public health pricing?

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* 15. NCSD and TrojanTM Brand Condoms may want to publish tweets or Facebook posts about this donation. Can we contact you to promote our partnership with your health department or organization?

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