Start Egg Donor Application

Step 1 of 9 - Qualify

11%

Age*

BMI*

Calculate your BMI here>>

Hidden

DISABLED - GPA*

Please enter a number from 1.0 to 4.0.

High School GPA*

Please enter a number from 1.0 to 4.0.

College GPA*

Please enter a number from 1.0 to 4.0.

Are you a smoker?*

Do you smoke cigarettes, e cigarettes, Vape , marijuana?

Yes

Do you have transportation to and from appointments?*

Yes

Are able to make early morning appts?*

Yes

Have you ever been formally diagnosed with a medical condition of any kind?*

Yes

Please state what the diagnosis is, approximate year of diagnosis, if you take medication for it and please include what kind and dosage, and any other information you think we should know.*

Thank you for for interest in egg donation. At this time you do not meet the industry standards to be an egg donor. If your circumstances change, we invite you to reapply.

Congratulations! You meet the initial criteria to become an egg donor. Please proceed to the egg donor application.

First Name*

Last Name*

Cell Phone*

Address*

City*

State*

Zip*

Date Of Birth*

MM slash DD slash YYYY

Email*

Marital Status*

Single

Married

Partnered

Divorced

Hobbies/Interests

Age*

Pregnancies*

Miscarriages*

Terminations*

# Children*

Child 1 DOB

MM slash DD slash YYYY

Child 2 DOB

MM slash DD slash YYYY

Child 3 DOB

MM slash DD slash YYYY

Occupation*

High School Years Completed*

Hidden

DISABLED - High School GPA - MOVED TO 1st Page*

SAT*

I took the SAT

I didn't take the SAT

SAT Score*

ACT*

I took the ACT

I didn't take the ACT

ACT Score*

Hidden

DISABLED - College GPA - MOVED TO 1st Page*

Education Completed*

GED

HS Diploma

Some College

Attending Technical School

Technical Degree / Certification

Attending College-Undergrad

Associates Degree

Bachelors Degree

Attending Grad School

Graduate Degree

Doctorate Degree

Have you or are you attending an IVY league school?*

Yes

Please list IVY league school name

Degree or Major*

Future Career/Industry Goal*

Religious Background*

Are you adopted?*

Yes

Are your parents adopted*

Yes

Which of your parents are adopted?*

Mother

Father

Do you have knowledge of your immediate family member's medical history? (biological siblings, parents, and grandparents)*

If you do not know this information please ask your family members as we will need this information to proceed with your application to become an egg donor. You cannot be considered to be an egg donor without this information

Yes

Ethnic Origin/ Ancestry (Please be specific, i.e. Italian, Irish, German, etc.)

Father's Ethnic Background (Please Choose a Minimum of One and a Maximum of Three):*

African American

American Indian

Brazilian

Chinese

Colombian

Czech

Dutch

English

Filipino

French

German

Greek

Indian

Irish

Israeli

Italian

Japanese

Jewish

Korean

Mexican

Norwegian

Polish

Portuguese

Russian

Salvadoran

Scottish

Slovakian

Spanish

Swedish

Taiwanese

Vietnamese

Welsh

Yugoslavian

Other

Mother's Ethnic Background (Please Choose a Minimum of One and a Maximum of Three):*

African American

American Indian

Brazilian

Chinese

Czech

Dutch

English

Filipino

French

German

Greek

Indian

Irish

Israeli

Italian

Japanese

Jewish

Korean

Mexican

Norwegian

Polish

Portuguese

Russian

Salvadoran

Scottish

Slovakian

Spanish

Swedish

Taiwanese

Vietnamese

Welsh

Yugoslavian

Other

Have you done DNA Genetic Testing?*

Yes

If you are chosen by an intended parent who lives outside the immediate area, are you willing to travel (all expenses paid for donor and companion)

Height*

Weight*

Right Handed, Left Handed, Ambidextrous*

Right Handed

Left Handed

Ambidextrous

Natural Hair Color*

Hair Type*

Curly

Wavy

Straight

Eye Color*

Corrective Lenses*

Yes

Other Distinguishing Features (dimples, large eyes, etc:*

Skin Color*

Very Fair

Fair

Medium

Olive

Dark

Body Build*

Petite

Small

Medium

Large

Contraceptive Method*

Medical Problems*

Yes

If Yes, Please Explain

Are you currently taking any medications?*

Yes

Please list medication(s):

Smoker*

Yes

How Long?*

Have you traveled outside the country in the last year?*

Yes

How did you hear about this program?*

Other - Please let us know how*

Have you been an egg donor before?*

Yes

If yes, how many times and when?*

Are you currently an available donor at another agency or doctor's office?*

Yes

Please list agency and doctor's office

Reason for donating*

Are you interested in open donation?*

Yes

Maybe

Are you willing to meet the intended parents?*

Yes

Maybe

Are you willing to exchange contact information with the intended parent?*

Yes

Maybe

Is your morning schedule flexible so that you may be seen by a physician between the hours of 7:00 AM and 10:30 AM for maximum of 12 visits?*

Yes

If you are chosen by an intended parent who lives outside the immediate area, are you willing to travel (all expenses paid for donor and companion)

Outside your immediate area, but within your state of residence?*

Yes

Outside your state of residence, but within the United States?*

Yes

Additional Information

Do you have access to photos from infancy to current*

Yes

Maybe

Upload A Current Unfiltered Photo of Yourself*

Accepted file types: jpg, jpeg, png, gif.FileTitleCaptionDescription

Please Upload A Current Photo.

I agree to send in a photo*

After hitting "Submit" below, please be prepared to send a recent photo of yourself by email to info@elitefertility.com. Please no filtered photos. NO APPLICATION WILL BE CONSIDERED WITHOUT A PHOTO.