Donor Profile:

Name:
City, State:
Age:
Race:
Maternal Ethnic Ancestry:
Paternal Ethnic Ancestry:
Height:
Weight:
Natural Hair Color:
Hair color as a child:
Natural Hair Texture:
Eye Color:
Physical Build:
Complexion:
Tanning Ability:
Predominant Hand:
Teeth:
Vision:
Hearing:
Distinguishing Characteristics:
Religion:
Birth Date:
Blood Type:
Sexual Orientation:
Smoker:
Drug Use:
Alcohol Use:
HIV status:
Have you ever been tested positive for an STD?
Additional:


Education / Intelligence

Education:
High School Grade Point Average:
What was your best subject in high school:
College Major:
College Grade Point Average:
Highest Grade In:
SAT Score:
Learning Disabilities:
If yes, please explain:
Have you ever taken an IQ test:
Date of test and score:
Profession:
Additional:


Personal Profile

Have you ever been arrested and/or convicted of a crime/felony?

Have you ever been under the care of a psychiatrist? If yes, please 
explain.

Have you ever received treatment for drug or alcohol abuse?

Do you drink alcohol? If yes, how often?

Do you take prescription and/or non-prescription drugs? If yes, 
please explain.

Have you recently or are you willing to take health related tests? 
(STD’s, drugs, HIV, etc…)

If yes, can you provide a recent test result?

Please list any significant illnesses you have had:

Have you ever had surgery? If yes, please explain.

Were you adopted?

Please describe your character (personality):

Please list any clubs, organizations, hobbies, interests, sports 
teams, activities, etc. you are or have been involved in:

Please describe any special skills, talents, and abilities you have:

Please describe your future goals (personal and career):

Please explain your reason for wanting to be a sperm donor:

What qualities do you consider to be most important in choosing to 
work with prospective parents?

Are you willing to meet any future children from the artificial 
insemination procedure once he/she turns 18?

Have you ever been a sperm donor before?

Additional information:



Reproductive Heath History

How many times have you produced a pregnancy?

Please list the approximate dates of pregnancies:

Please list the age, sex, and general health condition of each of the 
children:

Were all your children born healthy? If no, please explain.

Were any of them born prematurely?

Do you have legal or physical custody of any or all of the above 
children?

If no, please explain:

Did any of your pregnancies take longer than six months to 
conceive?

Did you need any medical assistance to conceive your children?




Family History:   (age and health status)

Donor:
Mother:
Father:
Siblings:
Maternal Grandmother:
Maternal Grandfather:
Paternal Grandmother:
Paternal Grandfather:



Extended Family Characteristics:

Mother
Year of birth:
Race:
Ethnic ancestry:
Height:
Weight:
Eye Color:
Natural Hair Color:
Hair type (ex: thin, wavy, straight, thick, etc.):
Vision:
Hearing:
Wear corrective lenses? If so, at what age did she start wearing 
them?
Complexion:
Tanning Ability:
Freckles:
Physical Build:
Sex and age of children:
Occupation:
Education:
Special skills, talents, abilities, hobbies:
General Health:
Type of personality:


Father
Year of birth:
Race:
Ethnic ancestry:
Height:
Weight:
Eye Color:
Natural Hair Color:
Hair type (ex: thin, wavy, straight, thick, etc.):
Vision:
Hearing:
Wear corrective lenses? If so, at what age did she start wearing 
them?
Complexion:
Tanning Ability:
Freckles:
Physical Build:
Sex and age of children:
Occupation:
Education:
Special skills, talents, abilities, hobbies:
General Health:
Type of personality:


Sibling
Sex:
Year of birth:
Race:
Ethnic ancestry:
Height:
Weight:
Eye Color:
Natural Hair Color:
Hair type (ex: thin, wavy, straight, thick, etc.):
Vision:
Hearing:
Wear corrective lenses? If so, at what age did she start wearing 
them?
Complexion:
Tanning Ability:
Freckles:
Physical Build:
Sex and age of children:
Occupation:
Education:
Special skills, talents, abilities, hobbies:
General Health:
Type of personality:


Sibling
Sex:
Year of birth:
Race:
Ethnic ancestry:
Height:
Weight:
Eye Color:
Natural Hair Color:
Hair type (ex: thin, wavy, straight, thick, etc.):
Vision:
Hearing:
Wear corrective lenses? If so, at what age did she start wearing 
them?
Complexion:
Tanning Ability:
Freckles:
Physical Build:
Sex and age of children:
Occupation:
Education:
Special skills, talents, abilities, hobbies:
General Health:
Type of personality:


Sibling
Sex:
Year of birth:
Race:
Ethnic ancestry:
Height:
Weight:
Eye Color:
Natural Hair Color:
Hair type (ex: thin, wavy, straight, thick, etc.):
Vision:
Hearing:
Wear corrective lenses? If so, at what age did she start wearing 
them?
Complexion:
Tanning Ability:
Freckles:
Physical Build:
Sex and age of children:
Occupation:
Education:
Special skills, talents, abilities, hobbies:
General Health:
Type of personality: