Step 1 of 2

50%
  • AUTOBIOGRAPHICAL QUESTIONNAIRE

    These questions should have already been answered by the surrogate applicant. Her husband (or significant other if not married but living with someone) must now must fill out this form separately. Please try to answer the questions as completely and accurately as possible. The more you can tell us about yourself and your family, the better we will be able to evaluate you, and the better your chances will be of getting selected.

  • 1. Where were you born? How big a town was it? Did you grow up mainly in this town? If not, please give a history of the moves your family made including the dates and places where you moved. Also, please give a summary of your ethnic background.
  • 2. What memories of your childhood do you have? Are there any that are particularly painful or wonderful? Why?
  • 3. What are your biological parents' names, ages, occupations, and marital status? If they are married, how long have they been married? If either has passed away, please state when and from what cause?
  • 4. If they aren't married, when were they divorced? How did that affect you?
  • 5. Where do your parents live now? How often do you see them?
  • 6. How well did you get along with them while you were growing up? How well do you get along with them now?
  • 7. Did your parents get along with each other? Did your family as a whole get along? If not, why not?
  • 8. If your parents are divorced, have either remarried? If so, when?
  • 9. If you have stepparents, what are their names, ages, and occupations?
  • 10. How well did you get along with either of them growing up? Where do they live now? How often do you see them?
  • 11. How many brothers and/or sisters do you have? What are their names, ages, and occupations? Where do they live? Are they married? Children? How well did you get along with him/her growing up? If you have step-sisters or step-brothers, please answer these questions as they relate to them also.
  • 12. Is there anyone who has been particularly influential in your life? Tell me about them and how they have been important to you.
  • 13. When do you see your family members? Do you enjoy spending time with your parents/brothers/sisters? If not, why not?
  • 14. BECAUSE OF RECENT PROBLEMS WITH FAMILY MEMBERS OBJECTING TO SURROGACY, YOU ARE NOW REQUIRED TO DISCUSS YOUR PARTICIPATION IN THE PROGRAM WITH BOTH YOUR AND YOUR SPOUSE'S FAMILY. DO NOT SEND THIS APPLICATION BACK TO US UNTIL YOU HAVE DONE SO. What were the various people's reactions when you told them what you were doing?
  • 15. What was your religious/spiritual upbringing? What do you think is the meaning of life? What do you see as your role in this world?
  • 16. Do you attend church now? If so, which one? Does your spouse and/or children also attend?
  • 17. Tell me about your high school experience. Did you enjoy it? Did you attend all your high school years at one school? If not, how many? What was your grade point average? Did you graduate? If so, when? If not, why not?
  • 18. What kinds of extracurricular activity did you participate in?
  • 19. Did you work while in high school? If so, what kinds of jobs did you have? How many hours did you work each week?
  • 20. Did you date during high school? Frequently or one person for a long time?