First, lets go over your academic career.

I attend or graduated from:

Stanford

Harvard

MIT Boston

Other accredited major university

What other accredited major university did you attend?

My undergraduate major/degree was in, or is anticipated to be in

I currently have or am seeking a graduate degree or equivalent education.

Yes

No

My study of focus was, or is anticipated to be:

My GPA range is:

3.00-3.50

3.51-3.90

3.91+

My ACT college admission score was:

My SAT college admission score was:

I am proud of the following academics accomplishments:

I am particularly proud of the following academics accomplishments:

I played a sport in college at least one full season:

Yes

No

I was a college athlete for this many years or more:

1-2

3-4 or more

None

My primary sport was:

Within my sport I am particularly proud of the following accomplishments:

Now, let's get to know some basic information about you.

My age is:

My age is

My height is:

My weight is:

My weight is: (or my BMI is?)

I (do/do not) have a major hereditary disorder that I am aware of:

I do

I do not

Thank you for considering being a donor, but we cannot accept your application.

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My natural hair color is:

My eye color is:

What is your ethnicity?

Let’s discuss your wishes surrounding your donation.

I would consider being an Egg Donor if my compensation was:

How much would you like to be compensated?

I would like to be contacted if I match, but the potential parents offer a lower number:

Yes

No

The lower number must be within a certain percentage of my listed number, specifically:

all information disclosed in this form is confidential.

However the lower number must be within a certain percentage of my listed number, specifically:

10%

20%

30%

Other %

What percentage lower are you willing to make?

I want a trust fund to be set up for any children of an Egg Donation, payable beginning at the age of 18:

Yes

No

The amount I’d like set aside in the trust:

$100,000

$200,000

$300,000

Other

What amount would you like set aside?

Biological Parent Parameters & Standards

In addition to the below listed parameters/standards, I would like to place the following parameters/standards on any prospective biological parent/s:

No individual or couple is allowed to participate unless they pass the following parameters/standards:

Non-removable parameters

Have a post-graduate degree or the equivalent,
Pass all genetic screening panels and tests,
Proof of gainful employment for at least 5 years running with no gaps in employment
No criminal history or history of restraining orders (other than traffic tickets or similar minor infractions).

Provide proof of setting up a trust fund for the child/children’s education on assistance, payable beginning at the age of 18 in an amount to be specified by the Egg Donor, if a match occurs and the Donor so requests.
Have a net worth of at least $1,000,000
Have maintained steady employment for at least the past 5 years, with an average total yearly income of greater than $500,000, or 10 years, with an average total yearly income of greater than $300,000
Participated in a college sport, or participated in a high school sport and received major university level academic achievements/accomplishments.
Have a BMI not less than 18 and not greater than 27,

Additional parameters may be listed or removed at the Egg Donor’s specific request (except the non-removable parameters listed above) should a preliminary match occur.

Biological Parent Parameters & Standards

All these parameters are fine

I have more parameters

What parameters would you like to add?

Unused Embryos

I am strongly pro-life and in the event there are any unused embryos I require that they be preserved and donated to a deserving couple who meets the minimum parameters/standards:

Unused Embryos

Yes

No

N/A

How would you like to keep in touch?

This submission is NOT a binding contract. It is merely an inquiry to consider being an Egg Donor if a possible match occurs with prospective parents.

First Name ONLY*

Phone:*

Email:*

How would you like to be contacted?

Phone

Email

Both

All information is confidential.

Phone

This field is for validation purposes and should be left unchanged.