Wufoo

Spring 2020 Condom Collective Application

Do you care about access to contraception and want to make a difference in your community? Join the Condom Collective - formerly known as the Great American Condom Campaign- and get a free box of 500 Trojan condoms!

The Condom Collective is a youth-led grassroots movement to make condoms available to every student who needs them. Contraceptives should be a right for all, and our SafeSites give free condoms to people who need them in their communities. College students in all 50 states give out 1,000,000 Trojan Brand condoms on their campuses every year, and they also organize to increase access to contraceptives. Our collective takes action to give young people access to free condoms, promote sexual health, advocate for condoms to be widely available, and make their communities a better place.

PLEASE APPLY BELOW. Applications will close by midnight, January 1st, 2020.

The program is for college students in the United States between the ages of 18 and 29. If you are a college/university staff member who is interested in purchasing discounted condoms, please visit trojanprofessional.com.

Have questions? Please email Geoff Corey at geoff@advocatesforyouth.org.

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About You

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Questions

Name * First Last
Birth Date * MM / DD / YYYY
Email Address *
Cell Phone Number * ### - ### - ####
A phone number is needed for shipping condoms. By providing your cell phone number, you agree to receive calls and texts to that number regarding Advocates for Youth.
SCHOOL NAME - IMPORTANT: Fill in the COMPLETE NAME of your college/university (e.g., University of California–San Francisco, State University of New York-Binghamton) *

Please type in the FULL NAME of your school -- NO abbreviations.
Select School Type (check all that apply) *
Public Private Technical/Vocational Community College Historically Black College/University (HBCU) Tribal College Hispanic Serving Institution Asian American and Native American Pacific Islander-Serving Institution (AANAPISI)
In which CITY is your school located? *
In which STATE is your school located? *
Year in School *
Do you live ON or OFF campus? *
ON campus OFF campus
IMPORTANT: Condoms will ship to you in early February. What will your SHIPPING address be at that time? It CANNOT be a P.O. Box! *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

If you live ON campus, please refer to your campus' guidelines for receiving packages/boxes.
How many undergraduates does your campus have? *
Most of my fellow students: *
Live ON campus Live NEAR campus Commute
Are you a residential advisor? *
Yes No
Please mark which of the following statements are true. Check all that apply: *
Students can get free condoms from my university (Resident Assistant, health center, etc.). Students can get free condoms from a student organization at my university. Condoms are not distributed on my campus. Condoms are not allowed on my campus. I don't know -- I'm not sure what my school's condom distribution policies are. Other
If you selected "Other." Please explain more about your school's condom distribution policies.
Which Gender Identity Best Describes You?
Cisgender Woman Cisgender Man Non-binary Trans woman (MTF) Trans man (FTM) Genderqueer Genderfluid Prefer not to answer Other or multiple

Cisgender is a term for people whose gender identity matches the sex that they were assigned at birth. For example, someone who identifies as a woman and was assigned female at birth is a cisgender woman. The term cisgender is the opposite of the word transgender.
Which Sexual Orientation Best Describes You?
Heterosexual Lesbian Gay Bisexual Queer Pansexual Asexual Prefer not to answer Other or multiple
Which Race/Ethnicity Best Describes You?
White Black or African American Latinx Asian/Pacific Islander South Asian Arab (Middle East/North Africa) Native American or Pacific Islander Prefer not to answer Other or multiple
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