Condom Request Form

This request form is intended exclusively for members of the York University community, including students, staff, and faculty. If you are not affiliated with York University, please contact your local community health centre for condom distribution services.

Please allow a minimum of 5 business days for processing all requests.

If your request is for a specific event and requires a large quantity (2,000 or more condoms), we strongly encourage you to submit your request as early as possible. This allows us to assess our inventory and confirm whether we can fulfill your request. If we are unable to meet the full quantity, we will notify you promptly so you can make alternative arrangements.

All requests are subject to availability. While we will do our best to fulfill your request, we may offer alternative options if your preferred quantity or type is not available.

Please note:
We do not offer delivery. All condom requests must be picked up in person from the Student Counselling, Health & Well-being (SCHW) office at Keele Campus, located in The Bennett Centre for Student Services, Room N110, between 9:00 AM and 4:00 PM

Thank you for your understanding and cooperation.

Contact Details:
I am ordering for: *

I am ordering for: A York U Department or Group Myself Other Other
If ordering for a department or group, please provide the name of the department/group
Contact Name: *
YORKU Email Address *
Request Details:

Please Note: The requested type and quantity are subject to availability and may not be guaranteed. We will do our best to accommodate your request and will communicate any changes or alternatives
Please specify the number of condoms you would like to receive. *
Type of Condoms (Check all that apply) *

Type of Condoms (Check all that apply) Latex External Condom Non-Latex External Condom Internal (Female) Condom Specific styles/size/themes (e.g., flavored, colorful, funny sayings)
Do you want Dental Dams? If so, how many?
Any additional comments or special instructions?
Condoms must be stored in a cool, dry place, away from heat, sunlight, and sharp objects. Handle with care to avoid damage, and check expiry dates regularly.

The Recipient is solely responsible for proper storage and handling. Student Counselling, Health and Well-being is not liable for any issues resulting from misuse or improper care. *

Condoms must be stored in a cool, dry place, away from heat, sunlight, and sharp objects. Handle with care to avoid damage, and check expiry dates regularly.

The Recipient is solely responsible for proper storage and handling. Student Counselling, Health and Well-being is not liable for any issues resulting from misuse or improper care. By ticking this box, I acknowledge that I have read, understood, and agree to follow the above storage and handling requirements.

Condom Request Form

Condom Request Form

Contact Details:

Request Details: Please Note: The requested type and quantity are subject to availability and may not be guaranteed. We will do our best to accommodate your request and will communicate any changes or alternatives

Request Details:

Please Note: The requested type and quantity are subject to availability and may not be guaranteed. We will do our best to accommodate your request and will communicate any changes or alternatives