Mask/Test Request Form
'Dores, use this form to request masks and rapid tests for yourself or student organizations! We will work with you to coordinate pick-ups.
Email
*
example@example.com
Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method:
*
Email or Text?
What are You Requesting? You can select multiple.
*
Masks
Rapid Tests
For yourself or a group?
*
Self
Group
Submit
Should be Empty: