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Condom Request Form

1.First and Last Name(Required.)
2.AU Student ID Number or JAGID(Required.)
I understand

* If form is not completed with correct information, (name and student ID) order will not be completed.
* I can only make 1 online request a month. But I can always come to Student Health to pick up free safe sex supplies during business hours.
* Condom choices will change slightly every month or as supply changes.
* Orders are filled first thing in the morning.
* If I chose to pick up at Student Health condoms will be held at reception for 3 days then returned.
3.Select your College(Required.)
4.This is my(Required.)
5.I would like to Request Latex or Non-Latex Condoms
Current Progress,
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