Become a Surrogate Complete our short surrogacy quiz to apply below. Name * First Name Last Name Email * Phone (###) ### #### What state do you live in? * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming How old are you? * Surrogates must be between 21-42 years old. Are you a U.S. Citizen? * Yes No Do you have children of your own, to whom you gave birth? * All surrogates must have one successful, full-term pregnancy before qualifying to carry for someone else. Yes, I am a proud mother Not yet, but I am currently pregnant No, I have not given birth How would you describe your financial situation? * I am able to cover my monthly expenses. I have some government assistance (Foodstamps, SNAP, WIC, etc.) I am struggling to/cannot cover my monthly expenses. Have you been vaccinated against COVID-19, or are you willing to be before becoming pregnant? * Yes, I am fully vaccinated No, but I plan to be No, but I am open to discussing this further No, and I do not plan to be How would you describe your pregnancy or pregnancies? * Perfectly healthy and uncomplicated. Pretty healthy, but I did have a manageable condition/minor issues. Complicated. I needed bed rest, medication, and/or other major complications. How do you feel about giving birth and not bringing home the baby? * Surrogacy is a selfless act to make someone else's dream a reality. You will complete a psychological evaluation before matching. I'm ready. I understand that I will be carrying someone else's child. I'm ready. I anticipate being emotional, but I am fine going home without a baby. I think it would be difficult for me to emotionally separate from a baby that I carried. What are your views on terminating a pregnancy? * Please answer honestly. We do not currently work with any agencies that will approve surrogates who are unwilling to terminate due to medical reasons. I am fine with it. I believe it is best left up to the medical professionals to determine. I believe termination is necessary in some instances, and I would be willing if medically necessary. I would not terminate a pregnancy under any circumstances. Why do you want to be a surrogate? * Please provide a brief explanation. Have you applied with any other surrogacy agencies or matching companies recently? Please give details. * How did you hear about us? Facebook Google Normalize Surrogacy Podcast Instagram Yelp Friend/Referral Other Thank you!
