UNMC Mask Request Form

Check UNMC's Masking Guidance for latest updates. This form is available for ordering surgical/disposable masks for delivery on campus.

Complete this form to submit a request for delivery of masks. Please check with others in your department/program that might also submit a request to confirm you are not placing duplicate orders for your group.

Note: you can NO LONGER ORDER KN95 masks through this request form.
To order KN95 masks, departments must place orders through SAP Ariba using their own cost center.

Request Date

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Phone:
Email Address:

UNMC distributed red cloth masks to all personnel earlier in the pandemic.

We are now taking additional requests for any NEW PERSONNEL and NEW STUDENTS who did not receive masks as part of the original distribution. These will be available for new personnel and new students at no cost until the supply is gone.

If you do not have new personnel, enter the number 0 into the field and continue to the next section to order disposable masks.

Total number of New Personnel needing cloth masks:

* must provide value

Number of Cloth Masks to Ship:

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UNMC has a supply of disposable surgical/procedural masks available for personnel who will be on campus.

Disposable masks come in a box containing 50 masks. Unfortunately, we can not accept requests for partial boxes.

Boxes of disposable masks will be billed at a cost of $20 per box, therefore a Cost Center or WBS number is required below.

NOTE: These are not N95 or KN95 masks.

Please check current UNMC masking guidance to confirm which should be worn on campus.

Total number of BOXES of Disposable Masks requested:
(each $20 box contains 50 masks)

* must provide value

Note: You are requesting a total of ______ masks (50 per box in ______ boxes).
You will be billed $______ to the account number you provide below.

Number of Disp Masks total:

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Number of Disposable Mask BOXES to Ship:

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Cost for Disp Masks ($20 per box):

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You can NO LONGER ORDER KN95 masks through this request form.

To order KN95 masks, departments must place orders
through SAP Ariba using their own cost center.

UNMC will now require KN95 masks for faculty, staff and students who are on campus, if not already in a fitted N95. UNMC has a supply of KN95 masks available for personnel who will be on campus.

KN95 masks come in a box containing 20 masks. Unfortunately, we can not accept requests for partial boxes. If placing requests for large numbers of boxes, you may be contacted by a team member to confirm need prior to shipping.

The base cost for boxes of KN95 masks will be covered by UNMC, however a Cost Center or WBS number will be is required to cover minor shipping charges for requests to other UNMC campuses outside of the Main Omaha campus (i.e. Lincoln, Norfolk, Kearney, or Scottsbluff-Gering). Failure to provide cost center for shipping charges will result in a delay.

Total number of BOXES of KN95 Masks requested:
(each box contains 20 masks)

* must provide value

kn95 total masks

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Note: You are requesting a total of ______ KN95 masks (20 per box).

Please provide your CAMPUS LOCATION below, then enter your BUILDING and ROOM NUMBER for delivery of your mask requests to your area.

Campus location for mask shipment:

* must provide value

Main Campus (Omaha)

Other UNMC Campus (outside Omaha)

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Which campus?

* must provide value

Lincoln

Norfolk

Kearney

Scottsbluff-Gering

Other

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4-DIGIT CAMPUS ZIP: 68198 -
(i.e. 68198-1234)

* must provide value

CHECK THAT YOU HAVE ENTERED THE CORRECT 4-DIGIT ZIP (DO NOT INCLUDE 68198)

BUILDING:

* must provide value

ROOM NUMBER:

* must provide value

Note: Since you are not ordering any disposable masks and/or are on the main UNMC Campus, no Cost Center or WBS is required.

Please provide a Cost Center (10 digits) or WBS (13 digits) account number for billing:

* must provide value

Note: Since you are requesting masks to a location other than the main UNMC campus, a small charge may need to be billed to cover shipping costs. Charges may vary based on campus location and quantity of boxes.
For more information, contact Shipping & Receiving.

Based on the information provided above, you are requesting the following:

______ KN95 Masks (requested ______ boxes, 20 masks per box)
______ Disposable Masks (requested ______ boxes, 50 masks per box)

If this is incorrect, please update your requested number of boxes in the fields above.

Note: Due to a high number of requests, if requesting larger quantities (more than 5 boxes), partial orders may need to be sent and full quantities delayed due to limited supply. We are working to get more supply on hand to fill all orders as requested.

You will receive a confirmation email at "______". Expect delivery of your masks within 1-2 business days.

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