This brief form helps us determine whether our structured donor participation program may be a good fit. Submission does not guarantee acceptance.
1. Full Legal Name *
2. Age *
3. State of Residence *
4. Email Address *
5. Phone Number *
6. Are you willing to donate only through licensed fertility clinics (no informal or at-home arrangements)? * YesNo
7. Are you comfortable with medical, genetic, and infectious disease screening? * YesNo
8. Are you willing to participate in psychological readiness screening if required? * YesNo
9. Do you understand donors do not have parental rights or financial responsibilities in our program? * YesNo
10. Are you willing to work with independent legal counsel to formalize donor agreements? * YesNo
11. Have you donated sperm before? * —Please choose an option—NoYes — through a clinicYes — through a private arrangement
If yes, please briefly explain (optional)
12. Are you willing to follow ethical limits on the number of families created with your donations? * YesNo
13. Desired level of future contact (if any) * —Please choose an option—No contactOpen to limited, structured contactOpen to identity release in the futureUnsure / would like more information
14. Why are you interested in becoming a donor through a structured, clinic-based program? *
15. Is there anything in your medical, family, or personal history that may be relevant to donor screening? (Optional)
I understand this program requires medical, legal, and ethical safeguards; informal or at-home donation is not permitted; submission does not create a donor relationship; and participation is subject to screening and approval.
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