Higher Education Prevention Services Request Form

Higher Education Prevention Services Request Form

Seretean Wellness Center - 108
As a part of the Higher Education Prevention Services Grant (HEPS) the Department of Wellness provides substance abuse prevention education and programing reagrding a variety of substances. Additionally, grant staff can provide free medictaion lock boxes and medictaion deactiviation bags upon request.

Please refer to the HEPS website for any additional information.
CWID*
Email*
example@example.com
Is your request for an individual or department

IndividualDepartment
Department Name
Please select all that apply to your request

Medication Lock BoxMedication disposal bagsNarcan Nasal Spray
Please select any of the following for your department

Medication lock boxesMedication disposal bagsNarcan nasal spray
Number of Medication Lockboxes you are requesting
Number of Narcan Nasal Sprays you are requesting
Once your request has been submitted, you will receive an email to schedule a time to pick up your requested items. If you have submitted your request but have not been contacted about scheduling a pick up time, please email kari.pratt@okstate.edu.
Should be Empty: