Shady Grove Fertility is the largest fertility center in the nation – matching more donors to recipients than any other center in the country. We are looking for donor applicants to complete their donations in Maryland, Virginia, DC and the greater Philadelphia area.
1. Are you a US citizen or permanent resident?
 
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2. Are you eligible to work in the US?
 
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3. FIRST name
 
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4. LAST name
 
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5. What is your zip code?
 
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6. Which of our full service offices is most convenient for you for frequent visits?
 
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7. Do you live or work within 1 hour of at least one of our full service offices?
 
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8. Which metro area is closest to you?
 
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9. What is your date of birth?
 
   
10. Primary phone number you want us to use to communicate with you?
 
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11. Even though you will ultimately be precisely measured for height in our office, please provide us your height?
 
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12. Even though you will be precisely weighed in our office, please provide us your current weight.
 
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13. What is your highest level of education?
 
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14. Have you ever donated your eggs or applied to be a donor?
 
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15. Will you be available to complete the egg donation in the next 4 – 6 months?
 
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16. Please describe the flexibility in your current day to day schedule.
 
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17. Even though you will be tested for nicotine, please answer the following question. Have you smoked in the last three months?
 
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18. Even though you will be tested for nicotine, please answer the following question. How many cigarettes do you smoke per day?
 
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19. How many alcoholic drinks do you usually consume in a week?
 
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20. When is the last time you had marijuana?
 
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21. When is the last time you have used other recreational drugs such as: Cocaine, Barbituates, Narcotics, Opiates, Amphetamines, Hallucinogens, Tranquilizers (non-medical), PCP, Inhalants, Steroids (non-medical), Ecstacy, or other recreational drug for NON-MEDICAL purposes?
 
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Please provide the name of the drug.
22. How many days have you spent in jail?
 
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23. Have you had a blood transfusion?
 
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If you have had a blood transfusion in another country, please specify the country and date.
24. Have you ever been previously excluded from donating blood?
 
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If yes, please identify the reason and dates.
25. How old were you when you first started having your period?
 
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26. What kind of birth control method are you CURRENTLY using?
 
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27. Have you had a Depo Provera shot within the last year?
 
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28. How many miscarriages have you had?
 
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29. Are your menstrual periods regular (24-36 days) when not on birth control pills?
 
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30. What is the average number of days from the beginning of one menstrual cycle to the start of the next menstrual cycle?
 
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31. Do you have both ovaries?
 
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32. Have you ever been told by a medical doctor you were infertile?
 
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If yes, when and on what basis?
33. Have you tested positive Chlamydia or Gonorrhea within the last year?
 
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34. Do you or one of your partners in the last 5 years have HIV, Hepatitis B or C, or has been an IV (intravenous) drug user?
 
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35. Have you lived or traveled to Europe for more than 3 months since 1980?
 
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If yes, please list the country, year and the amount of time spent there.
36. How did you first learn about the opportunity to donate your eggs at Shady Grove Fertility Center?
 
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Please include the name of the person who referred you.
37. We use a secure server for online convenience and privacy. Email related to your application will come to you from our server with the email address of: no-reply@donorapplication.com. To ensure timely communication about your application (typically same day or 1 day) please add "donorapplication.com" to your safe list. Your email address will not be used for spam. Instructions on how to add "donorapplication.com" to a safe list is easily found if you Google "add email address to safe list using Outlook", assuming "Outlook" is your email client.
 
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38. What is your email address for communication with you regarding your pre-screen application?
   
39. What is your preferred password for future login reference?
   (6-20 characters with 4 or more letters and 1 or more numbers)  
40. Verify your password.
   

Please add no-reply@donorapplication.com to your email contact list to prevent our response from being flagged as spam.