School Narcan Request Form – Snohomish County Health Department

Eligibility: All school districts located in Snohomish County can request one unit (two doses) of nasal spray Narcan for each of their middle and high schools.

Instructions: Please include all the schools that you will be distributing Narcan to in one request. You will be mailed your unit(s) to the address provided on this form. If staff at your school needs training or educational materials for students, please indicate this below. If a unit is administered, please email opioids@snohd.org out to report the use and request a replacement. Please contact us when your unit is within three months of its expiration date.

Please contact opioids@snohd.org with any questions about Narcan distribution.

School Narcan Request Form - Snohomish County Health Department

School District *

Arlington
Darrington
Edmonds
Everett
Granite Falls
Index
Lake Stevens
Lakewood
Marysville
Monroe
Mukilteo
Northshore
Snohomish
Stanwood Camano
Sultan
Other

If other please specify

Recipient School(s) *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Name *

First

Last

Primary Contact Email *

Primary Contact Phone Number *

Do you need overdose/substance use training for your staff? If this is a need, please provide any specific topic requests, the audience needing training (school nurses, teachers, administrators, support staff, etc.), the number of attendees expected, a preference for a virtual, hybrid, or in-person training, and the time of day preferred for a training. If this information is not currently available, please indicate this below.

Are you in need of educational materials for your school(s) such as posters or pocket resource guides? If yes, please describe your needs below.

Any additional requests or questions?

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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Site Updated - November 3, 2023

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