Do I Qualify to Be a Surrogate?

First Name

Middle Name (Type N/A if you don't have a middle name)

Last Name

Maiden Name (if applicable)

Date of Birth

Sun Mon Tue Wed Thu Fri Sat

Phone Number

Email Address

City

State

Zip

Country

Do you have a REAL ID-compliant driver's license (or other acceptable form of ID like a passport) to board domestic flights in the U.S.? This is now required for travel as of May 7, 2025

Are you a United States Citizen?

If you are not a United States Citizen, do you have permanent residence in the United States? (example: you are a Green Card Holder)

Are you a registered member of a Native American tribe? (If yes, please note that some tribes require formal permission to participate in a surrogacy journey. This documentation would need to be included in your legal agreement with the intended parents.)

Please list the name of your tribe (This helps us ensure we support you with any additional steps that may be needed.)

Height

'

"

Current Weight (in pounds)

lbs

Are you or your children currently on any state-funded or government assistance programs? (Including welfare food stamps, housing assistance, or government-provided free medical health insurance like Medicaid)

Please select all of the state-funded/government programs you are currently needing

SSI (Supplemental Security Income)

SNAP (Supplemental Nutrition Assistance Program, a.k.a. Food Stamps)

WIC (Women, Infants, and Children)

Medicaid

Section 8 Housing Choice Voucher Program

Public Housing

State Unemployment Benefits

Other

Done any travel outside the country within the last 6 months?

Fun! Where did you go?

When were you there?

Sun Mon Tue Wed Thu Fri Sat

Do you have any travel plans for next year or two? (This either out-of-state and/or out-of-country)

Exciting! Where are you headed?

When are you planning on going?

How long are you planning to stay there? We ask only because we want to make sure we are working are your availability!

Have you ever been arrested or convicted for a crime? *This is NOT an automatic disqualifier, so please be as honest as possible!

Sometimes stuff happens! What year did this occur?

How old were you when this happened?

Can you give me more details about the circumstances and what happened?

Are you currently serving in the U.S. Military as Active Duty or Reserves? - Some branches of the military may require formal approval to participate in a surrogacy journey. If applicable, this documentation would need to be included in your legal agreement with the intended parents.

Please indicate your branch of service This helps us provide accurate guidance regarding any required approvals

Are you active duty or in the reserves?

Are you on Facebook? We would love to have you join our private Surro Connections Surrogate Group!

Great! What is the name listed on your Facebook so that we can find you? You can also copy your Facebook page URL and paste it here, too!

What is your preferred method of contact for us to reach out to you?

How else would you like to be contacted?

Would you like to opt into our monthly e-newsletter? We won't SPAM you or sell your information ever, scout's honor!