Gifted Journeys

Donor Application Form

'*' Indicates required fields
'#' "Indicates fields viewed by the Intended Parents

"INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED."

Contact Information



Present Address
First Name:*	Last Name:*

Your first name and photographs will be viewed by intended parents. For your privacy, please choose the pseudonym you would like for your profile: *
Email Address:*	Phone number:*
City:*	Mailing Address:*

ZipCode:	State:*
Social Security #:
Same as above

Permanent Address
Name:	Phone number:
Email Address:	Mailing Address:
City:	State:
Emergency Contact:	Ethnicity:*	African American Armenian Asian Caucasian Egyptian Hispanic Indian Jewish Middle East Native American
Maternal Heritage:	Paternal Heritage:

How did you hear about us? *

Stats
Date of Birth:*	(MM/DD/YYYY)	Religious Affiliation:*
Exact Height:*	(Eg: x' y")	Weight:*
Body Type:*		Natural Hair Color:*
Hair Texture:		Eye Color:*
Complexion:		Marital Status:
What kind of birth control are you on?		Blood Type:
	* Hormone IUD, Implant BC or Depo-Shot will need be removed 6 months prior to donating.

Have you ever been convicted of a crime?	Yes No If yes, please explain: (all donors are subject to criminal background checks upon acceptance into the program)

Gifted Journeys | 10000 Riverside Drive, Suite 4 | Toluca Lake CA | 91602 | 818-505-3026 p. | 818-505-3028 f.