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This is the pre-screen application (Step 1 of 2).

Based on your answers, you will receive an email to see if you qualify for the next step.

When you submit your pre-screen application, you will be forwarded to a page that contains an additional application link.
If your pre-screen was approved, you will be able to immediately log in to complete the overall application (Step 2).

If you get a message that says your pre-screen is still under review, we will respond with an email from no-reply@donorapplication.com.
Please make sure you add no-reply@donorapplication.com to your approved list and/or check your filters for this email ... Thank you.

 Center for Reproductive Health - Spokane

1.

Today's Date *

2.

First Name *

3.

Last Name *

4.

City *

5.

State *

6.

Primary Phone *

7.

Email Address *

8.

Date of Birth *

9.

What race and/or ethnicity best represents you? *

10.

What is your height? *

11.

What is your current weight (in lbs.)? Note: just enter numbers ... example: 107 *

12.

Years completed of high school: *

13.

Have you ever been hospitalized for psychiatric care, seen by a counselor, or been on medication? *

14.

Do you use nicotine products (i.e. cigarettes, e-cigarettes, nicotine gum, etc.)? *

15.

Have you ever been convicted of a crime? *

16.

Have you ever spent time in jail? *

17.

Are you currently breastfeeding? *

18.

Are you adopted? *

19.

Are there genetic or medical conditions that run in your family? *

20.

Please explain your motivation for becoming an egg donor. *

21.

Are you able to provide detailed information about your relatives on both your maternal and paternal sides of the family including parents, siblings, grandparents, aunts, and uncles? *

22.

How did you hear about this donor program? *


What is your email address for communication with you regarding your pre-screen application?
(6-20 characters with 4 or more letters and 1 or more numbers)
(Must match)


Center for Reproductive Health
508 W. 6th Avenue, Suite 500, Spokane, WA 99204
(509) 822-6942 or (800) 334-1409