Thank you for your interest in the egg donation at Reproductive Biology Associates (RBA). Please complete the pre-screening application and click on submit for review. The staff at RBA will notify you by e-mail if you have been approved to continue the screening process. If approved, the next step is to complete the donor profile/application. It may take up to 2 business days to receive an e-mail which include a link to complete the more extensive profile/application.
1. Are you a US citizen or permanent resident?
 
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If not; Please Explain
2. Are you eligible to work in the United States?
 
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3. What is your FIRST name?
 
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4. What is your LAST name?
 
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5. What is your mailing address?
 
Address Street Address Apartment City State Zip Code
Mailing Address::          
6. What is the primary phone number (include area code) to use for contact and leaving messages?
 
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7. Which best describes your level of education?
 
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Degree Earned/ Major:
8. Is your work schedule flexible?
 
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Please provide times when you definitely are not available.
9. How many times have you donated?
 
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10. What is your date of birth?
 
   
11. What is your height?
 
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12. What is your weight?
 
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13. What race would you most likely be affiliated?
 
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Please Explain
14. What is your eye color?
 
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15. What is your natural hair color?
 
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16. In the past 12 months, have you had sex with a man who has had sex with another man in the past 5 years?
 
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Please Explain
17. In the past 12 months, have you been in jail for more than 3 days in a row?
 
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Please Explain
18. In the past 12 months, have you been in close contact (i.e. sharing kitchen and bathroom) with a person having active viral hepatitis?
 
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Please Explain
19. Do you currently smoke cigarettes?
 
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20. In the past 12 months, have you had a positive syphilis test?
 
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Please Explain
21. In the past 12 months, have you been treated for gonorrhea or chlamydia?
 
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Please Explain
22. Have you spent 3 months or more cumulative in the United Kingdom from 1980 through 1996?
 
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Please Explain
23. From 1980 through 1990, were you a member of the US military, a civilian military employee or a dependent of a member of the US military, residing in US military bases in Northern Europe (Germany, Belgium and the Netherlands) for 6 months or more, or elsewhere in Europe (Greece, Turkey, Spain, Portugal, Italy) for 6 months or more from 1980 through 1996?
 
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Please Explain
24. Have you spent 5 or more years cumulative in Europe?
 
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Please Explain
25. Were you born in, have you lived in, or traveled to any African country since 1977?
 
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Please Explain
26. How did you hear about us?
 




















Please provide which website, radio station, newspaper or person who referred you.
27. What is your email address for communication with you regarding your pre-screen application?
   
28. What is your preferred password for future login reference?
   (6-20 characters with 4 or more letters and 1 or more numbers)  
29. Verify your password.
   

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