GC Website Pre-Application | The Stork's Nest

Before proceeding to the application, there are a few requirements that must be met. Please answer all questions in a truthful and factual manner to the best of your ability. All identifying information will be kept confidential and will not be released to potential recipients without your permission.

First Name

Middle Name

Last Name

Preferred Pronouns

Email

Phone Number

Date of Birth

Sun Mon Tue Wed Thu Fri Sat

Are you a US Citizen?

Unfortunately, we cannot work with applicants who are not a US Citizen. We appreciate your desire to become a surrogate however we cannot proceed at this time. There is no need to continue this application.

Do you reside in Michigan?

Unfortunately, we cannot work with applicants who reside in Michigan. We appreciate your desire to become a surrogate however we cannot proceed at this time. There is no need to continue this application.

Country

City

State

What is your height?

'

"

What is your current weight?

lbs

Do you exercise?

What kind of exercise and how often?

What is your diet like?

Are you willing to change your diet if the parents request it or have a specific diet that they would want you to follow (i.e. organic, no pork, no processed meats, etc.)?

Have you had at least one successful pregnancy & delivery?

Unfortunately, we cannot work with applicants who have not given birth before. We appreciate your desire to become a surrogate however we cannot proceed at this time. There is no need to continue this application.

Are you currently in a relationship?

What is your relationship status?

If A Resulting Child Has A Genetic Abnormality That Is Discovered During The Pregnancy, Would You Be Willing To Terminate The Pregnancy at the Parents Request and if Physician Recommended?

*Please explain in detail your thoughts on terminating in this situation and what your boundaries if any would be.

Are you willing to terminate the pregnancy if the resulting child is diagnosed with Down Syndrome?

If A Resulting Child Has A Physical Abnormality That Is Discovered During The Pregnancy, Would You Be Willing To Terminate The Pregnancy at the Parents Request and if Physician Recommended?

*Please explain in detail your thoughts on terminating in this situation and what your boundaries if any would be.

Would you consider reducing the number of fetuses you're carrying if the Intended Parent(s) requested it and Physician Recommended?

*Please explain in detail your thoughts on terminating in this situation and what your boundaries if any would be.