Donor Nexus Egg Donor Application

Thank you for your interest in becoming an egg donor! Your complete honesty and accuracy are essential when filling out this application. Once you've completed the application, you will receive an email from Donor Nexus within the next few days. Thank you!

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* 1. Please provide the following information

First and last name

City/Town

State/Province

Email address

Phone number

Can we send text messages to this number?

How did you hear about Donor Nexus?

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* 2. Becoming an egg donor is a serious commitment. There are several important considerations we want you to be aware of. Please answer accordingly by entering 'yes' in the text box next to each statement.

I understand that being an egg donor is a serious committment and that the intended parents have placed an incredible amount of trust in their egg donor to comply with instructions and to do what it is expected of them to make eventual pregnancy a success.

As an egg donor, I understand that I would be required to keep approximately 6 different doctors appointments throughtout my cycle, which are between the hours of 7:30 am - 9:30 am.

As an egg donor, I am required to undergo a procedure under sedation to remove my eggs from my ovaries at the conclusion of my cycle.

As an egg donor, I understand that the requirements for application be that I am a female, between the ages of 19-29, a non-smoker, non-drug user and that I have a heathly BMI.

I understand that as an egg donor, I am required to take self-administered injections for approximately 22 days.

I understand that I am responsible for responding to all communications from Donor Nexus within 24 hours (via text, phone or email). Failure to do so on 3 attempts may result in donor disqualification.

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* 3. Why do you want to become an egg donor?

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* 4. What is your ethnicity? (Please select all that apply.)

American Indian or Alaskan Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White / Caucasian

Prefer not to answer

Other (please specify)

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* 5. What is your natural hair and eye color?

Natural hair color?

Eye color?

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* 6. What is your date of birth?

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* 7. What is your height (in feet and inches) and weight (in pounds)?

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* 8. What is the highest level of education you have completed?

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* 9. Have you been an egg donor before? If yes, please specify the year and the results

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* 10. Medical History

Have you ever been pregnant?

Have you ever had an abortion?

Have you ever had an STD?