Mask and Glove Request Form

Mask and Glove Request Form
Accessibility

The State of Colorado is committed to providing equitable access to our services to all Coloradans. View the Accessibility, Interpretation & Translation Support page.

To report digital accessibility barriers or request accommodations, complete the CDPS Issue Reporting, Accommodation and Translation Request Webform and/or email: cdps.ovpconnect@state.co.us.
Name*

First NameLast Name
Email*
example@example.com
Agency Name*
Important Information

Requests for masks and gloves will be fulfilled in the order they are received, until supplies run out.

Supplies going to those in the Denver Metro area need to be picked up at the OVP office. The pickup address is: 700 Kipling St. Lakewood, CO 80215.

Please note, we have a limited ability to ship the supplies for those outside of the Denver metro area.
Are you able to pick-up the supplies?*

YesNo
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter the number of BOXES of each item you are requesting.

1 Box of Nitrile Disposable Gloves = 200 gloves

1 Box of N95 Masks = 50 masks
Masks
Number of boxes being requested (50 per box)
Gloves
Number of boxes being requested (200 per box)
For questions: cdps.ovpconnect@state.co.us.
Should be Empty: