You can only apply for yourself and others that live in your house that need period items, We are requesting information (age etc) for stats only.  

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We have very limted free period cups, so if you request one we will do our best to get one out to you, if we cant send you a cup we will send you other period items. If you would like to request a cup please fill out this form HERE

Which gender identity do you identify with
Do you hold a Community Services Card
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What pack do you need-Please on pick one

Please only request items for people in your household, If you are requesting a family pack please fill in below what each person needs & give their first name and age, if this info is not given then what you have requested for them will not be sent.
Please only select one pack per person

Person 2
Person 3
Person 3

Thanks for submitting!