Initial Surrogacy Program Application

Below is the initial online application to our surrogacy program. It goes over the basic requirements needed to become a gestational surrogate mother. Additionally, it helps our agency ensure that those looking to find a surrogate mother are matched up with their most ideal candidate. The surrogacy program application also provides some insight on what being a surrogate mother is like.

Dear prospective surrogate:

Before proceeding to the application stage, there are a few important considerations that you must be aware of, please read the following statements carefully and answer accordingly. More information on these matters is available on our website.

1. I understand that as a surrogacy candidate, I must have delivered at least one child of my own that I am currently raising.
Yes

2. I understand that as a surrogacy candidate, the primary requirements for application are that I be a female, between the age of 21-38, a non-smoker, non-drug user and that I am neither significantly overweight nor underweight for my height.
Yes

3. I understand that as a surrogacy candidate, I must live in a stable, non-smoking household, and must possess reliable transportation.
Yes

4. I understand that as a surrogacy candidate, I must not be a recipient of any state or federal financial assistance (welfare). 
Yes

5. I understand that as a surrogacy candidate, I would be excluded from the program if I, and/or my partner have been arrested or been in a substance abuse program within the last 10 years.
Yes

6. I understand that as a surrogacy candidate, a full background screen will be conducted on both me and my partner if applicable.
Yes

7. I understand that as a surrogacy candidate, a full female medical examination will be performed to determine my suitability, including an STD screen, drug screen, Hepatitis test and a pelvic ultrasound.
Yes

8. I understand that as a surrogacy candidate, I cannot have had any previous pregnancy complications (bleeding, gestational diabetes, pre term labor)
Yes

9. I understand that as a surrogacy candidate, I must be a United States citizen.
Yes