THANK YOU FOR SUBMITTING YOUR APPLICATION – NEXT STEP:
Congratulations, you are through the online portion of the Surrogate Application.
To finalize your application, please complete the last few steps listed below.
- Please contact Mr. Litz at (317) 996-2000 within 48 hours to discuss your application. This is the ONLY WAY that you will be able to participate in the program. If we do not hear from you in the next 48 hours, your application will not be processed.
- If you are married (or living with someone), please have him complete the ‘Husband’ portion of the Autobiographical Questionnaire, which is here: Husband’s Portion of Application
- Complete the offline portion of the application. If you have not already, you will need to download the ‘Surrogate Application Part 2’ form below which contains your Medical Release Form and Criminal History Release Form. You can click here to download the form
If you are unable to download these forms, please give us a call at 1-888-SURROGATE, and we’ll be happy to mail one to you.
Surrogate Application Checklist
Please review this list and be sure you have completed each item. All items must be completed prior to acceptance into the surrogacy program.
- You have received and read all of the information include with the application, especially the material on the types of programs offered, the legal status of surrogacy, and the information on health insurance.
- You have discussed surrogacy with family members and those people you listed as references.
- You have filled out the medical release form, and sent it to the doctor(s) who has your pregnancy records, and NOT sent it back to us.
- You (and your husband or significant other, if applicable) have completed the criminal history form, and delivered it to your county sheriff’s office, and NOT sent it back to us.
- You (and your husband or significant other, if applicable) have each completed the autobiographical questionnaire.
- You have included two good pictures of yourself and your family.
- If you are not on the pill or Norplant, you have begun (or will begin when you start your period) charting your temperature according to the instructions on the charts.
- You have answered all questions honestly and accurately.
- You (and your husband or significant other, if applicable) have signed the application (or initialed electronically).
If you have any questions regarding the application or the application process, please give us a call at 1-888-SURROGATE, and we’ll be happy to assist you.
You will need Adobe Acrobat Reader for some portions of this application. If you have problems viewing this file, you can download the Acrobat Reader free here.