Sperm Donor Application

Apply to Change a Life.

Much like egg donors, sperm donors are so needed in the world as many battle infertility in a variety of ways. We appreciate you for applying. Please be as honest and thorough as you can.

Name(Required)

First Middle Last

Preferred Name/Nickname(Required)

Date of Birth(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Height(Required)

Weight(Required)

Eye Color(Required)

Hair Color(Required)

Where were you born/raised?(Required)

What is your ethnicity?(Required)

Skin Type?(Required)

What is your maternal ancestry line?(Required)

What is your paternal ancestry line?(Required)

What Blood Type are you?(Required)

Have you previously donated sperm? If yes, explain.(Required)

Are you currently enrolled in school? If yes, where?(Required)

What is your highest level of education? What is the name of that school?(Required)

ACT and SAT Score? (Or the equivalent in your country)(Required)

What is/was your major/field of study?(Required)

Any achievements or honors of note?(Required)

Can you legally work in the U.S.?(Required)

Are you currently working? If so, what is your occupation?(Required)

How many alcoholic drinks do you consume per week?(Required)

How often do you smoke cigarettes/vape?(Required)

How often do you use Marijuana?(Required)

Have you had any tattoos or piercings in the last twelve months? If yes, explain.(Required)

Have you ever used Testosterone Replacement Therapy or Anabolic Steroids? If yes, explain.(Required)

Have you had any cosmetic surgeries? If yes, explain.(Required)

Do you currently have any health challenges (diabetes, thyroid issues etc.) If yes, explain.(Required)

Are you currently taking medications? If yes, explain.(Required)

Is there a history of cancer in your family? If yes, explain.(Required)

Is there a history of other serious illnesses in your family? If yes, explain.(Required)

Is there any history of mental illness in your family? Have you been diagnosed with depression, ADHD, or ADD? If yes, explain.(Required)

Do you currently take any medication for mental health? If yes, explain.(Required)

Have you suffered previously from any serious illnesses, disabilities or health challenges? If yes, explain.(Required)

Have you had a confirmed positive test or treatment for gonorrhea, chlamydia, or syphilis in the past 12 months? If yes, explain.(Required)

Have you ever tested positive for HIV or HTLV? If yes, explain.(Required)

Have you ever been diagnosed with Hepatitis B or C? If yes, explain.(Required)

Your sexual partners are…?(Required)

How many sexual partners have you had in the past six months?(Required)

Why do you want to donate sperm?(Required)

Are you reliable, committed to the process and able to show up to appointments?(Required)

After your initial sperm deposit at the clinic, you will most likely need to be retested on an STD panel 3-6 months later due to FDA regulations. Are you willing to go back into a local lab for a quick blood draw 3-6 months after?(Required)

Do you plan on traveling outside the United States within the next 6 months? If so, when & where?(Required)

Have you been in a Zika risk area in the past twelve months (i.e. Brazil, Mexico, etc?)(Required)

What is your religious affiliation, if any?(Required)

Are you okay donating to single or LGBTQ parents?(Required)

Do you mind sharing your Instagram, Facebook, or TikTok handle? If so, what is it?(Required)

What rate of compensation are you hoping for?(Required)

Where did you hear about Elevate?(Required)

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