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Initial Surrogacy Program Application

Below is the initial online application to our surrogacy program. It goes over the basic requirements needed to become a gestational surrogate mother. Additionally, it helps our agency ensure that those looking to find a surrogate mother are matched up with their most ideal candidate. The surrogacy program application also provides some insight on what being a surrogate mother is like.

Dear prospective surrogate:

Before proceeding to the application stage, there are a few important considerations that you must be aware of, please read the following statements carefully and answer accordingly. More information on these matters is available on our website.

1. I understand that as a surrogacy candidate, I must have delivered at least one child of my own that I am currently raising.
Yes

2. I understand that as a surrogacy candidate, the primary requirements for application are that I be a female, between the age of 21-38, a non-smoker, non-drug user and that I am neither significantly overweight nor underweight for my height.
Yes

3. I understand that as a surrogacy candidate, I must live in a stable, non-smoking household, and must possess reliable transportation.
Yes

4. I understand that as a surrogacy candidate, I must not be a recipient of any state or federal financial assistance (welfare). 
Yes

5. I understand that as a surrogacy candidate, I would be excluded from the program if I, and/or my partner have been arrested or been in a substance abuse program within the last 10 years.
Yes

6. I understand that as a surrogacy candidate, a full background screen will be conducted on both me and my partner if applicable.
Yes

7. I understand that as a surrogacy candidate, a full female medical examination will be performed to determine my suitability, including an STD screen, drug screen, Hepatitis test and a pelvic ultrasound.
Yes

8. I understand that as a surrogacy candidate, I cannot have had any previous pregnancy complications (bleeding, gestational diabetes, pre term labor)
Yes

 
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The Surrogacy SOURCE agency features surrogate mothers in Northern California (San Francisco), Southern California (San Diego, Orange County, Inland Empire), Colorado, Florida, Chicago, Illinois, Boston, Massachusetts, Vermont, New Jersey, Connecticut, Rhode Island, Maine, Baltimore, Maryland, Texas & Las Vegas, Nevada. Our surrogate mother program serves the United States and provides international surrogacy options. Interested in becoming a surrogate? Learn more about our exceptional group of surrogate mothers. Interested in finding a surrogate? Learn about our international surrogacy program, surrogate mother costs and requirements.
 
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