diff --git a/static/app/views/settings/organizationIntegrations/integrationRequest/RequestIntegrationModal.tsx b/static/app/views/settings/organizationIntegrations/integrationRequest/RequestIntegrationModal.tsx
index ee0d2c41c8e6cc..f4c764b22b253d 100644
--- a/static/app/views/settings/organizationIntegrations/integrationRequest/RequestIntegrationModal.tsx
+++ b/static/app/views/settings/organizationIntegrations/integrationRequest/RequestIntegrationModal.tsx
@@ -1,17 +1,17 @@
-import {Fragment, useState} from 'react';
 import {useMutation} from '@tanstack/react-query';
+import {z} from 'zod';
 
-import {Button} from '@sentry/scraps/button';
+import {defaultFormOptions, useScrapsForm} from '@sentry/scraps/form';
 
 import {addErrorMessage, addSuccessMessage} from 'sentry/actionCreators/indicator';
 import type {ModalRenderProps} from 'sentry/actionCreators/modal';
-import {TextareaField} from 'sentry/components/forms/fields/textareaField';
 import {t} from 'sentry/locale';
 import type {IntegrationType} from 'sentry/types/integrations';
 import {trackIntegrationAnalytics} from 'sentry/utils/integrationUtil';
 import {useApi} from 'sentry/utils/useApi';
 import {useOrganization} from 'sentry/utils/useOrganization';
 import {TextBlock} from 'sentry/views/settings/components/text/textBlock';
+
 type Props = {
   name: string;
   onSuccess: () => void;
@@ -19,14 +19,16 @@ type Props = {
   type: IntegrationType;
 } & ModalRenderProps;
 
+const schema = z.object({
+  message: z.string(),
+});
+
 /**
  * This modal serves as a non-owner's confirmation step before sending
  * organization owners an email requesting a new organization integration. It
  * lets the user attach an optional message to be included in the email.
  */
 export function RequestIntegrationModal(props: Props) {
-  const [isSending, setIsSending] = useState(false);
-  const [message, setMessage] = useState('');
   const organization = useOrganization();
   const api = useApi({persistInFlight: true});
 
@@ -35,18 +37,16 @@ export function RequestIntegrationModal(props: Props) {
   const endpoint = `/organizations/${organization.slug}/integration-requests/`;
 
   const sendRequestMutation = useMutation({
-    mutationFn: () => {
-      return api.requestPromise(endpoint, {
+    mutationFn: (data: z.infer<typeof schema>) =>
+      api.requestPromise(endpoint, {
         method: 'POST',
         data: {
           providerSlug: slug,
           providerType: type,
-          message,
+          message: data.message,
         },
-      });
-    },
+      }),
     onMutate: () => {
-      setIsSending(true);
       trackIntegrationAnalytics('integrations.request_install', {
         integration_type: type,
         integration: slug,
@@ -55,20 +55,23 @@ export function RequestIntegrationModal(props: Props) {
     },
     onSuccess: () => {
       addSuccessMessage(t('Request successfully sent.'));
-      setIsSending(false);
       onSuccess();
       closeModal();
     },
     onError: () => {
-      addErrorMessage('Error sending the request');
-      setIsSending(false);
+      addErrorMessage(t('Error sending the request'));
     },
   });
 
-  const buttonText = isSending ? t('Sending Request') : t('Send Request');
+  const form = useScrapsForm({
+    ...defaultFormOptions,
+    defaultValues: {message: ''},
+    validators: {onDynamic: schema},
+    onSubmit: ({value}) => sendRequestMutation.mutateAsync(value).catch(() => {}),
+  });
 
   return (
-    <Fragment>
+    <form.AppForm form={form}>
       <Header>
         <h4>{t('Request %s Installation', name)}</h4>
         <CloseButton />
@@ -86,15 +89,17 @@ export function RequestIntegrationModal(props: Props) {
             name
           )}
         </TextBlock>
-        <TextareaField
-          inline={false}
-          flexibleControlStateSize
-          stacked
-          name="message"
-          type="string"
-          onChange={setMessage}
-          placeholder={t('Optional message…')}
-        />
+        <form.AppField name="message">
+          {field => (
+            <field.Layout.Stack label={t('Message')}>
+              <field.TextArea
+                value={field.state.value}
+                onChange={field.handleChange}
+                placeholder={t('Optional message…')}
+              />
+            </field.Layout.Stack>
+          )}
+        </form.AppField>
         <TextBlock>
           {t(
             'When you click “Send Request”, we’ll email your request to your organization’s owners. So just keep that in mind.'
@@ -102,8 +107,8 @@ export function RequestIntegrationModal(props: Props) {
         </TextBlock>
       </Body>
       <Footer>
-        <Button onClick={() => sendRequestMutation.mutate()}>{buttonText}</Button>
+        <form.SubmitButton>{t('Send Request')}</form.SubmitButton>
       </Footer>
-    </Fragment>
+    </form.AppForm>
   );
 }