Personal Information

ID%ID% Status%Status%
Submission ID%Submission ID% Submission Time%Submission Time%
Signature%Signature% Signature Date%Signature Date%
Photo%Photo% Photo (2)%Photo (2)%
Photo (3)%Photo (3)% Photo (4)%Photo (4)%
First Name%First Name% Last Name%Last Name%
Nickname%Nickname% ————
Ethnicity%Ethnicity% Primary Ethnicity%Primary Ethnicity%
Secondary Ethnicity%Secondary Ethnicity% Adopted%Adopted%
Member of Clubs%Member of Clubs%————
Attended or Won Medal in Sports Competition%Attended or Won Medal in International/National/State Sports Competition%Sports Competition Details%Sports Competition Details%
Birth Date%Birth Date% Age%Age%
Address%Address% City%City%
State (Country)%State (Country)% Email%Email%
Primary Phone%Primary Phone% Secondary Phone%Secondary Phone%
Best Way to Reach%Best Way to Reach% Best Time to Call%Best Time to Call%
Country of Citizenship%Country of Citizenship% Country of Birth%Country of Birth%
Emergency Contact Name%Emergency Contact Name% Emergency Contact Phone%Emergency Contact Phone%
Marital Status%Marital Status% ————
Spouse Name%Spouse Name% Spouse Phone Number%Spouse Phone Number%

General Information

Prior Sperm Donor%Prior Sperm Donor% Past Sperm Donations%Past Sperm Donations%
Last Sperm Donation Date%Last Sperm Donation Date%————
Health Insured%Health Insured% Health Insurance Provider%Health Insurance Provider%
Sperm Donation Restriction%Sperm Donation Restriction% Sperm Donation Restriction Details%Sperm Donation Restriction Details%
Blood Type%Blood Type% Blood RH Factor%Blood RH Factor%
Height (ft/inch)%Height (ft/inch)% Height (cm)%Height (cm)%
Weight (LB)%Weight (LB)% Body Shape%Body Shape%
Natural Hair Color%Natural Hair Color% Eye Color%Eye Color%
Skin Color%Skin Color% ————
Family Genetic Disease%Family Genetic Disease% Family Genetic Disease Details%Family Genetic Disease Details%

Education and Employment

Highest Degree Earned%Highest Degree Earned% School Name%School Name%
Major%Major% Education Background%Education Background%
SAT Score%SAT Score% ACT Score%ACT Score%
GRE SCore%GRE SCore% GMAT Score%GMAT Score%
LSAT Score%LSAT Score% GPA%GPA%
Plan for Further Education%Plan for Further Education% Plan for Further Education Details%Plan for Further Education Details%
Current Working Status%Current Working Status% Current Job Title%Current Job Title%
Current Employer%Current Employer% Current Employer Address%Current Employer Address%
Employment History%Employment History% ————

Medical History

Smoking%Smoking% Years of Smoking%Years of Smoking%
Drinking%Drinking% How Often of Drinking%How Often of Drinking%
Medication Taking%Medication Taking% Medication Taking Details%Medication Taking Details%
Normal Naked-eye Vision%Normal Naked-eye Vision% Naked-eye Vision Issues%Naked-eye Vision Issues%
Normal Hearing%Normal Hearing% Hearing Issues%Hearing Issues%
Teeth Condition%Teeth Condition% ————
Prior Allergy%Prior Allergy% Prior Allergy Details%Prior Allergy Details%
Prior Chronic Problem%Prior Chronic Problem% Prior Chronic Problem Details%Prior Chronic Problem Details%
Taken Growth Hormones%Taken Growth Hormones% Taken Growth Hormones Details%Taken Growth Hormones Details%
Prior Infectious Disease%Prior Infectious Disease% Infectious Disease in Past 5 Years%Infectious Disease in Past 5 Years%
Infectious Disease 5 Years Ago%Infectious Disease 5 Years Ago% ————
Prior Surgery%Prior Surgery% Surgery in Past 5 Years%Surgery in Past 5 Years%
Surgery 5 Years Ago%Surgery 5 Years Ago% ————
Prior Hospitalization (Other than Surgery)%Prior Hospitalization (Other than Surgery)% Prior Hospitalization in Past 5 Years%Prior Hospitalization in Past 5 Years%
Prior Hospitalization 5 Years Ago%Prior Hospitalization 5 Years Ago% ————
Prior Mental Issue%Prior Mental Issue% Mental Issues%Mental Issues%
Mental Treatment in Past 6 Months%Mental Treatment in Past 6 Months% Mental Treatment 6 Months Ago%Mental Treatment 6 Months Ago%
Prior Blood Donation Rejection%Prior Blood Donation Rejection% Prior Blood Donation Rejection Details%Prior Blood Donation Rejection Details%

Reproductive History

Any Prior Reproductive Illness%Any Prior Reproductive Illness% Prior Reproductive Illness%Prior Reproductive Illness%
Prior Reproductive Illness Treatment%Prior Reproductive Illness Treatment% ————
Sexually Active%Sexually Active% Months with Current Partner%Months with Current Partner%
Current Relationship Monogamous%Current Relationship Monogamous% Number of Partners in Past 1 Year%Number of Partners in Past 1 Year%
Any STD Partner%Any STD Partner% STD Partner Details%STD Partner Details%

Personality

Why Sperm Donor%Why Sperm Donor% Aware by Family%Aware by Family%
Any Parents not Donating to%Any Parents not Donating to% Non-Donation Details%Non-Donation Details%
Peferred Relationship with Intended Parents%Peferred Relationship with Intended Parents% Preferred Relationship Details%Preferred Relationship Details%
Self Description%Self Description% Personality Strength%Personality Strength%
Personality Weakness%Personality Weakness% Prior Greatest Achievement%Prior Greatest Achievement%
Hobbies%Hobbies% Favorite Music%Favorite Music%
Favorite Books%Favorite Books% Favorite Sports%Favorite Sports%
Favorite Food%Favorite Food% ————
Idols in Heart%Idols in Heart% Reasons%Reasons%
Vegetarian%Vegetarian% Owning Pet%Owning Pet%
Enjoying Travel%Enjoying Travel% Favorite Travel Places%Favorite Travel Places%
Languages Growing up with%Languages Growing up with% Languages Speaking%Languages Speaking%
Exercise%Exercise% Exercise Details%Exercise Details%

Family — Siblings and Children

Number of Siblings%Number of Siblings% Number of Brothers%Number of Brothers%
Number of Sisters%Number of Sisters% ————
Any Health Issue of Sibling%Any Health Issue of Sibling% Details of Sibling Health Issues%Details of Sibling Health Issues%
Number of Children%Number of Children% ————
Any Health Issue of Children%Any Health Issue of Children% Details of Children Health Issues%Details of Children Health Issues%

Family — Parents

Mother Ethnicity%Mother Ethnicity% Mother Alive%Mother Alive%
Mother Current/At-death Age%Mother Current/At-death Age% ————
Mother Height (foot/inch)%Mother Height (foot/inch)% Mother Weight (LB)%Mother Weight (LB)%
Mother Blood Type%Mother Blood Type% Mother Blood RH Factor%Mother Blood RH Factor%
Any Mother Health/Mental Issue%Any Mother Health/Mental Issue% Mother Health/Mental Issue Details%Mother Health/Mental Issue Details%
Any Mother Sibling%Any Mother Sibling% Number of Mother Siblings%Number of Mother Siblings%
Health/Mental Issue of Mother Siblings%Health/Mental Issue of Mother Siblings% ————
Mother Past Career%Mother Past Career% ————
Father Ethnicity%Father Ethnicity% Father Alive%Father Alive%
Father Current/At-death Age%Father Current/At-death Age% ————
Father Height (foot/inch)%Father Height (foot/inch)% Father Weight (LB)%Father Weight (LB)%
Father Blood Type%Father Blood Type% Father Blood RH Factor%Father Blood RH Factor%
Any Father Health/Mental Issue%Any Father Health/Mental Issue% Father Health/Mental Issue Details%Father Health/Mental Issue Details%
Any Father Sibling%Any Father Sibling% Number of Father Siblings%Number of Father Siblings%
Health/Mental Issue of Father Siblings%Health/Mental Issue of Father Siblings% ————
Father Past Career%Father Past Career% ————

Family — Grand Parents

Maternal Grandmother (MGM) Ethnicity%Maternal Grandmother (MGM) Ethnicity% MGM Alive%MGM Alive%
MGM Current/At-death Age%MGM Current/At-death Age% ————
MGM Height (foot/inch)%MGM Height (foot/inch)% MGM Weight (LB)%MGM Weight (LB)%
MGM Blood Type%MGM Blood Type% MGM Blood RH Factor%MGM Blood RH Factor%
Any MGM Health/Mental Issue%Any MGM Health/Mental Issue% MGM Health/Mental Issue Details%MGM Health/Mental Issue Details%
Maternal Grandfather (MGF) Ethnicity%Maternal Grandfather (MGF) Ethnicity% MGF Alive%MGF Alive%
MGF Current/At-death Age%MGF Current/At-death Age% ————
MGF Height (foot/inch)%MGF Height (foot/inch)% MGF Weight (LB)%MGF Weight (LB)%
MGF Blood Type%MGF Blood Type% MGF Blood RH Factor%MGF Blood RH Factor%
Any MGF Health/Mental Issue%Any MGF Health/Mental Issue% MGF Health/Mental Issue Details%MGF Health/Mental Issue Details%
Paternal Grandmother (PGM) Ethnicity%Paternal Grandmother (PGM) Ethnicity% PGM Alive%PGM Alive%
PGM Current/At-death Age%PGM Current/At-death Age% ————
PGM Height (foot/inch)%PGM Height (foot/inch)% PGM Weight (LB)%PGM Weight (LB)%
PGM Blood Type%PGM Blood Type% PGM Blood RH Factor%PGM Blood RH Factor%
Any PGM Health/Mental Issue%Any PGM Health/Mental Issue% PGM Health/Mental Issue Details%PGM Health/Mental Issue Details%
Paternal Grandfather (PGF) Ethnicity%Paternal Grandfather (PGF) Ethnicity% PGF Alive%PGF Alive%
PGF Current/At-death Age%PGF Current/At-death Age% ————
PGF Height (foot/inch)%PGF Height (foot/inch)% PGF Weight (LB)%PGF Weight (LB)%
PGF Blood Type%PGF Blood Type% PGF Blood RH Factor%PGF Blood RH Factor%
Any PGF Health/Mental Issue%Any PGF Health/Mental Issue% PGF Health/Mental Issue Details%PGF Health/Mental Issue Details%