Sperm Donor Application - New Dawn Surrogacy

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Intended Parents
Surrogates
Blog
Donors
- Egg Donor Requirements
- Sperm Donor Application

Become a Donor

Help Others Build Their Family

First Name *

Last Name *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province

ZIP / Postal Code

Country *

How do you prefer to be contacted? *

What is your relationship status? *

What is your preferred pronoun? *

Please enter your preferred pronoun.

What is your height?

Feet *

Inches *

What is your weight? *Please enter in pounds.

What is your hair color? *

What is your eye color? *

What is your skin type? *

What is your race?If applicable, include multiple races.

What is your sexual orientation? *

What is your ethnicity?If applicable, enter multiple ethnicities, separated by commas.

From your mother's side? *

From your father's side? *

Are you religious? If so, which religion(s)?

Are you employed or studying? *

Are you legally able to work in the US? *YesNoE.g. Yes/No

What is your highest completed level of education? *

What college did/do you attend?

What is/was your field of study?

Any achievements or honors in school or work?

How often do you use marijuana or hemp? *NeverOnce or twice everOnce or twice a yearSix or more times a yearMonthlyWeeklyDailyRecreationally, medically, or otherwise.

How often do you smoke or vape? *NeverOnce or twice everOnce or twice a yearSix or more times a yearMonthlyWeeklyDailyTobacco, nicotine, marijuana, or otherwise.

How often do you drink? *NeverOnce or twice everOnce or twice a yearSix or more times a yearMonthlyWeeklyDaily

What is your blood type? *

Have you undergone testosterone therapy? *

Do you currently suffer from any health concerns? If so, explain. *

Have suffered from any health concerns in the past? If so, explain. *

Please list any and all medications you have taken within the past year, including supplements? *Whether it be for physical health or mental health, prescription or OTC, please include it all!

Have you, or anyone in your family, been diagnosed with any of the following?

Heart Disease *FamilyMyselfNo

Heart Attack *FamilyMyselfNo

Stroke *FamilyMyselfNo

High Blood Pressure *FamilyMyselfNo

Diabetes *FamilyMyselfNo

Epilepsy *FamilyMyselfNo

Cancer *FamilyMyselfNo

Mental Illness *FamilyMyselfNo

Intellectual Impairment *FamilyMyselfNo

Genetic Disorder *FamilyMyselfNo

Alcoholism or Substance Abuse *FamilyMyselfNo

Mental Illness *FamilyMyselfNo

If you indicated that a family member has suffered from any of the above, please explain. *

If you indicated that you have suffered from any of the above, please explain. *

Do you or your family have any other history of serious illness? If so, explain. *

Do you or your family have any other history of mental illness? If so, explain. *

Are both of your bioligical parents still alive? *

Mother's age of death and cause of death. *Please be as descriptive as possible.

Father's age of death and cause of death. *Please be as descriptive as possible.

Are both of your bioligical grandparents still alive? *

Grandmother's age of death and cause of death. *Please be as descriptive as possible.

Grandfather's age of death and cause of death. *Please be as descriptive as possible.

How would you describe your general health? *

Are you currently sexually active? *

Your sexual partners are primarily? *

How many sexual partners have you had in the past 6 months?

Have you or your sexual partners traveled or lived outside of the US in the past 6 months? *Yes, livedYes, traveledNoCheck all that apply.

Have you ever tested positive for any STDs or STIs? *

Which STDs/STIs, and how long ago?

Which have you been diagnosed with?

Have you had any tattoos or piercings within the past 12 months? *TattoosPiercingsNeitherCheck all that apply.

Have you been diagnosed with any of the following? *HIVHTLVHepatitis BHepatitis CHepatitis of Unknown EtiologyOtherNoneCheck all that apply.

Why are you looking to become a sperm donor? *

Have you ever donated sperm before - or - are you applying to other agencies?If so, please explain.

What type of parents are you willing to donate to? *LGBTQ+ CouplesHeterosexual CouplesSinglesAnyoneCheck all that apply.

What is your desired compensation rate?

USD

Amounts should be in USD.

Do you have any social media accounts you're willing to share? If so, please list your username(s).

Have you ever been convicted of a felony or misdemeanor? *If so, please explain.

Please upload 3-5 photos of yourself! *

Drag and Drop (or) Choose Files