Donor Application

It takes about 20 minutes. Every application is read personally by Yolanda.

Personal Information

First Name

Last Name Country

Date of Birth Current Occupation Height

Weight

Eye Color Natural Hair Colour Natural Hair Texture Complexion Predominant Hand Blood Group Religion Are you adopted? Ethnicity and/or Race

Ancestry

For each family member, share their ethnicity and country of origin.

Family Member	Ethnicity and/or Race	Country of Origin
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Father
Mother

Education

Did you complete High School? Favourite subjects at school Years of education after High School What did you study? Currently enrolled at any educational institution? What are you studying? Other learning programs or classes completed

Personal Profile

If you could meet anyone in the world (living or deceased), who would it be and why? How would you describe your personality and character? Are you or have you ever been involved in any clubs, hobbies, interests, organizations, sports teams, activities, etc.? I am passionate about... and why I don't have much free time but when I do I… Food likes and dislikes Tell us about your special skills, talents and abilities What do you do for fun when you have time?

Medical History

Have you had any major surgeries? Are you taking any medications, herbs, supplements? Do you take any prescription drugs? Are you currently being treated for any medical condition? Have you ever been under the care of a psychiatrist? How much and how often do you drink alcohol? Do you smoke? Please list any significant illnesses you have had and at what age Are you willing to take health-related tests at the expense of the prospective parents?

Family Health History

Have any of your immediate blood family ever had any of the following health issues? If yes, who had it and at what age.

	You/Sib.	Age of onset	Parents	Grandparents

Reproductive Health History

Have you had reproductive illnesses or diseases? Is there a history of twins in your family? Do you have a regular menstrual cycle? Do you have any children? Which type of birth control are you using?

Your Message & Motivation

If you could send a message to your prospective recipient, what would it be? Explain your personal reasons for wanting to be an egg donor.

Confidential Information

Full Legal Name Maiden Name Home Phone Place of Employment Work Phone Cell Phone Current Home Address ID / Passport Number Do you have a passport?

Emergency Contacts (min 2)

Contact 1 — Name Contact 1 — Phone Contact 2 — Name Contact 2 — Phone

Final Questions

Have you donated your eggs previously? Would you want to know if a pregnancy resulted from your egg donation? If a child is born from your eggs, what is your relationship to this child? Would you be willing to meet the child/children in the future if they wanted to know about their genetic roots?

Account Access

Email Address (for login)

Password

Confirm Password

I confirm the information provided is accurate, and I agree to the Privacy Policy and Terms.