Fertility Alternatives, Inc.
Preliminary Egg Donor Application
This is a preliminary application.
A full application will be faxed, mailed, or emailed to qualifying applicants.
Please note: You must agree to be available, in the event Fertility Alternatives,
Inc. locates a match for you.

Please review the following information prior to filling out this preliminary
application.
Preliminary applications who have not returned the Full Application within 30
days, will be removed from our files.

Only donors living in the U.S. will be accepted into the program.

Please apply only if you will be available when a match is made.
Although we do not ask that you exclusively work with us, we do kindly request
that you give us the standard minimum of 6 months to 1 year before you apply
with other agencies or donor programs.

As a premier egg donor program, you will be seen on our donor list!
We have a waiting list of recipients waiting for the right donor.
We would like the opportunity to match you and provide you with the service
you deserve.


Please do not apply if you are over the age of 31, a smoker, use illegal drugs,
or live outside of the U.S.

Do not fill out this form until you have read and clearly understand the
information provided on the EGG DONOR INFORMATION PAGE.
Serious applicants only, please.
Please answer ALL questions honestly and
completely.
AGE
RACE
Have you even been
pregnant?
ETHNICITY
Religious Background
Marital Status
If you are married or have a
partner, please be sure you will
have his/her support before
you apply with this program.
Do you have any genetic disease or
illness that runs in the family?
(i.e. cancers, Diabetes, color blindness,
Fragile X syndrome, Cystic Fibrosis, or
other genetically carried disorder)
If yes, please explain
Have you been diagnosed with
PCOS or other fertility problem?
If yes, Please explain
Are you using any form of hormonal
birth control?
(i.e. pill, patch, injection, nuvaring, etc.)
If so, what?
Are you taking any medications
other than birth control pills? If yes,
what are you taking and its
purpose?
Have you or any of your family
members been diagnosed with any
psychological disorders that may be
genetic?
(i.e. hyperactivity, Bi-polar disorder,
schizophrenia, clinical depression, etc.)
If yes, Please explain.
Have you or are you attending a
college or University?
If so, please indicate the name of the
university, course of study, and your
GPA.
If you have already graduated please
state when and where you
graduated, your GPA and the degree
earned.
Are you able to provide proof of
your college transcripts and/or your
SAT/ACT scores?
You will be required to provide some
documentation proving your educational
status if you are applying for  
"Exceptional Donor" status.
If needed, are you available for a cycle
that requires travel?
Most travelling cycles, require 1-2 days for
screening, and 7-10 days for the egg retrieval
procedure. Monitoring will be done in your local
area.
Travel is not a requirement but will get you
matched significantly sooner and more often
than if you were only available for local matches.
Why would you like to be an egg donor?
and
What is the negotiable amount of
compensation you would like to request?
Please see Fertility Alternatives, Inc. Egg Donor
Information Page for reasonable guideline.*
Please note: The average first time Exceptional Egg Donor is asked to start at a compensation of $8000.
Exceptional Donors are defined are women under the age of 30, with SAT scores 1250+ (ACT
score 30+) and/or college GPA of 3.0 or higher.
(Documentation Required)
Exceptional Donors are reasonably attractive, height/weight proportionate, have graduated
from or currently attending a university. (Ivy League preferred but not necessary.)
If you believe you qualify for Exceptional Donor Status, please check here.
How did you hear about Fertility Alternatives, Inc?
(Be specific.)
NOTE: Egg Donor applicants must have photos on file in order to be accepted into the program and
to be added to the egg donor database. Please be sure you include them with your full application if
you receive one.
Full applications may be mailed in a plain handwritten envelope for privacy purposes.

Ideal egg donor candidates must pass a preliminary screening process to include this online
preliminary application. Egg Donor applicants will be assessed on how serious they are about the
process, based on a timely return of the full application and the ability to be contacted when needed.
Feel free to email a photo of yourself to Fertility Alternatives, Inc.
We currently have a waiting list of couples in need of their ideal Donor.
Your help is greatly appreciated!