Confidential Application

Step 1 of 13

  • Dear Potential Surrogate Mother:

    Thank you for your interest in our program. If you would like the brochure that we typically send to surrogates, please let us know, and we will send it to you. Please follow these instructions carefully:

        Complete the online application in its entirety. This is a lengthy application and should be completed in one sitting. Please allow plenty of time to carefully consider and answer each question.
        Complete the online autobiographical questionnaire about you, your family, your spouse, etc. This is a form prepared by our psychologist and both you and your husband (or significant other if you are living with someone) need to fill it out separately.
        Print and complete a medical records release form to be sent to whichever doctor(s) delivered your child(ren). It more than one doctor was involved, make a copy of this and give it to each doctor who would have your pregnancy records. DO NOT RETURN THIS FORM TO US. SEND IT TO YOUR DOCTOR.
        Print and complete a criminal history release form to be delivered to your local law enforcement agency. DO NOT RETURN THIS FORM TO US. Take it or mail it to your local sheriff’s or police department. (You will need to download the 'Surrogate Application Part 2' form to complete steps 3)
        You can click here to download the form.

    Once I receive your application, I will review it and call you to go over it. I will also answer any questions you may have about the program. If you do not have a phone, you will need to call us from someone’s home a week after you’ve sent us the application. If you have not heard from us within a week, please contact us.

    After the initial interview with me, I will draw up a profile sheet that summarizes the things the couples would want to know about you. That profile sheet is then shown to the couples that are looking for surrogates.

    Once a couple indicates that they are interested in working with you, I will call you and give you the same type of information about the couple that I given them about you. You can decide if they sound like the type of people for whom you’d like to do this. If so, we will send your application to our psychologist, and he will call you to go over it and schedule a time for you to come here for the full psychological testing.

    Because we have such an active surrogate program, it is important that you return the application as soon as possible. Please review the checklist included with this packet to make sure you’ve done everything we’ve asked. If you have any questions about any of this, feel free to call.

    Thank you again for your interest in our program. You are about to become involved in a wonderfully rewarding experience, and you will be providing the most valuable gift imaginable to people who desperately want a child. We look forward to hearing from you.

    Very Truly Yours,Steven C. Litz

    To begin the application press the "Next" button below. (Reminder, please do not start this application unless you have adequate time to complete it)

Press the "Next" button above to begin the online application.