Donor Information Request Form

Midwest Sperm Bank

Sperm Donor Requirements

– MUST BE IN THE CHICAGOLAND AREA

-MUST have reliable transportation

-At least 5′ 10″ tall

– Between 21 and 40 years old

– Sexual partners are exclusively female

– Currently attending a four-year university, or, already hold a bachelors or advanced degree

– Are in good health

Your Personal Information

We need some personal information so we know how to contact you. The information you provide is strictly confidential, read more in our privacy policy.

Compensation will be discussed upon initial acceptance into the program.

Email Address

Cell Phone Number

First Name

Last Name

City, State (where you currently live)

Date of Birth

Height

Weight

hair color

Eye Color

Please provide a brief description of your personal medical history and background

Please provide a brief description of your education, occupation, citizenship, and anything else you would like to tell us.

Will you be in the area for the next 12 to 18 months?

Do you reside or work close enough to visit twice a week?

Are you able to donate at least once a week?