Order Narcan® for Community Groups
Delaware County Centralized Coordinating Entity Narcan Request Form
Please read before using this form:
▪ 1 Narcan kit contains 2 doses, you cannot request a single dose.
▪ You may not receive the number of kits you are requesting as we have a limited number.
▪ If this request is for a public or community event, you must turn in a Post- Event Form within 2 weeks of the end of the event
▪ For questions, please contact Sara Senkow at firstname.lastname@example.org
▪ Please fill this out in its entirety. If we receive incomplete forms, your request may not be filled.
▪ If you are requesting more than 10 kits, you must submit this form at least 1 week prior to the event.
Community Group Order Form
For more information about this program please call or text 610-285-9999.
An initiative of the Delaware County District Attorney’s Office