Thank you for beginning the process to help someone in need! This is the initial application once you complete it we will evaluate your application to make sure it is compatible with FDA law, professional association guidelines, the interest of the fertility centers we support and our own internal policies.

If you are ACCEPTED to the next stage:

You will receive an email from no-reply@donorapplication.com. This email contains a link, your username and password you just selected, and additional instructions. This information helps you complete the entire application.
1. By selecting "Agree", you are stating that you have answered all questions to the best of your ability, without purposeful omission or deception. You understand that egg donation is considered "tissue donation" according to the FDA. This is a process that requires maturity, as it is a serious issue related to all parties involved.
 
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2. By selecting "Agree", you are stating that you understand the importance of remaining anonymous to the recipient. Las Vegas Egg Donation will make reasonable efforts to protect your identity. Certain questions and answers are not shared with recipients online, but all questions and answers will be shared with the fertility center that is considering you for their program for final eligibility and treatment.
 
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3. By selecting "Agree", you are stating that you understand the role of this Internet agency (Las Vegas Egg Donation). As an Internet agency, the Las Vegas Egg Donation role is primarily limited to recruiting, 1st and 2nd stage eligibility verification, promotion and presentation of donors to recipients, and online selection of donor(s) by recipients and/or fertility centers.
 
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4. What is your FIRST name?
 
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5. What is your LAST name?
 
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6. Were you born in the USA?
 
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7. Are you eligible to work in the United States?
 
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8. Are you a US citizen or permanent resident?
 
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9. Fertilization
 
Cycles 1st Cycle 2nd Cycle 3rd Cycle 4th Cycle 5th Cycle
Date::          
# Eggs:          
Fertilized:          
PG::          
# Babies:          
10. With this treatment, you will need to travel to the IVF center on a regular (sometimes daily) basis. Which metropolitan area is closest to you?
 
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11. City
 
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12. State
 
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13. How did you hear about our Agency?
 
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14. What is the primary phone number (include area code) to use for contact and leaving messages?
 
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15. Is this phone number able to receive text messages that can be used to communicate with you?
 
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16. What is your marital status?
 
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17. Have you applied or been screened to be an egg donor before?
 
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If yes, provide the name and location of the donor program(s).
18. Are you currently enrolled as an egg donor in another program?
 
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19. How many times have you donated your eggs?
 
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20. Date of Birth (only your calculated age is shared with Recipients)
 
   
21. What is your height?
 
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22. What is your weight?
 
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23. How many cigarettes do you smoke per day?
 
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24. When is the last time you had marijuana?
 
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25. If a background check were run on you, would it show any problems with the law (i.e. theft, fraud, violence, possession of drugs, DUI, custody issues, lawsuits)?
 
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If yes, please explain.
26. How many drinks do you usually consume in a week?
 
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27. What race would you most likely be affiliated?
 
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Please describe "Other"
28. When is the last time you have used recreational or illicit drugs (cocaine, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinogens, tranquilizers, PCP, steroids for non-medical reasons, or etc.)?
 
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29. What is your highest level of completed education?
 
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30. Do you have medical insurance?
 
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What is the name of your insurance company?
31. What is your email address for communication with you regarding your pre-screen application?
   
32. What is your preferred password for future login reference?
   (6-20 characters with 4 or more letters and 1 or more numbers)  
33. Verify your password.
   

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