Education Sector (Schools and Early Childhood Education) - COVID-19 Antigen Test Request Form

1. Organization Information

Please use the form below to request your free At-Home Rapid COVID-19 Antigen Tests.
Please submit requests for antigen tests on an as-needed basis but no more than once a week per address.
Shipments are sent out once a week but can take up to 3 weeks for delivery and are dependent on available inventory.
For At-Home Rapid COVID-19 Antigen Tests, you will be receiving an email from us with additional information and an estimated delivery date.
As of February 1, 2023, we are no longer distributing PPE.

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* 1. Please enter your school/program name.

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* 2. Non-profit or For-profit Organization?

Non-Profit

For-Profit

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* 3. Choose your school/program type.

Early Childhood Education (preschool, FCC or other childcare)

Education Sector (TK-12)

Youth Camps & After School Programs

Other (please specify)

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* 4. What category best describes your Organization?

Other (please specify)

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* 5. If you are in a Unified School District, list your school district name below.

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* 6. Enter your school/program's street address for DELIVERY (address of receiving location). Please note the delivery address must be located in Los Angeles County and cannot be a P.O. Box.
Example: 200 N Spring St

Education Sector (Schools and Early Childhood Education) - COVID-19 Antigen Test Request Form

1. Organization Information

Question Title

* 1. Please enter your school/program name.

Question Title

* 2. Non-profit or For-profit Organization?

Question Title

* 3. Choose your school/program type.

Question Title

* 4. What category best describes your Organization?

Question Title

* 5. If you are in a Unified School District, list your school district name below.

Question Title

* 6. Enter your school/program's street address for DELIVERY (address of receiving location). Please note the delivery address must be located in Los Angeles County and cannot be a P.O. Box.
Example: 200 N Spring St

Question Title

* 7. Enter your school/program's unit or suite number.
Enter "N/A" if not applicable.

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* 8. Enter your school/program's City.

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* 9. Enter your school/program's 5 digit zip code.

Education Sector (Schools and Early Childhood Education) - COVID-19 Antigen Test Request Form

1. Organization Information

Question Title

* 1. Please enter your school/program name.

Question Title

* 2. Non-profit or For-profit Organization?

Question Title

* 3. Choose your school/program type.

Question Title

* 4. What category best describes your Organization?

Question Title

* 5. If you are in a Unified School District, list your school district name below.

Question Title

* 6. Enter your school/program's street address for DELIVERY (address of receiving location). Please note the delivery address must be located in Los Angeles County and cannot be a P.O. Box.Example: 200 N Spring St

Question Title

* 7. Enter your school/program's unit or suite number. Enter "N/A" if not applicable.

Question Title

* 8. Enter your school/program's City.

Question Title

* 9. Enter your school/program's 5 digit zip code.

* 6. Enter your school/program's street address for DELIVERY (address of receiving location). Please note the delivery address must be located in Los Angeles County and cannot be a P.O. Box.
Example: 200 N Spring St

* 7. Enter your school/program's unit or suite number.
Enter "N/A" if not applicable.