Step 1 Application Process Checklist
Application (prior to formal submission of your profile to a donor)
Disclaimer/contract (contract 1 prior to formal submission of your profile to a donor)
Dear Genetic Parent/s Letter
Profile, collage/photos of family, home, etc
Release of Information
Disclosure
Fees (application and disclaimer fees due to officially submit profile)
Mail, scan, or fax: 1. completed application, 2. disclaimer, 3. release of information 4. disclosure 5. fees
EmbryosAlive@yahoo.com Fax: 513-793-0052 or 727-489-2427
Approved Homestudy Yes No If No homestudy has been completed, Please provide the following documents.
7B
Step 2 Dossier Checklist
Contract 2 and balance of Fees
* (balance of fees are due upon acceptance of match or $50.00 per day late fees accrue after 48 hours late past 7 days may result in loss of match)
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Letter of Understanding of process
9
Physician's letter (stating you could carry a child to term)
10
Criminal History (webcheck)
11
Affidavit of Criminal History
12
Embryo Agreement and Relinquishment (email us) (A and R)
13
4 References (non-relative)
14
Proof of income (pay stub/current income tax/employer letter)
15
Release of Information 2
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Release to photograph
17
Protocol awareness letter (thawing protocol may not be available)
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Home Owners Insurance (copy)
19
Health Insurance (copy)
20
Life insurance (copy)
21
Will (or letter regarding the will) notarized
22
BMV or DMV (Bureau of Motor Vehicles or Dept. of Motor Vehicles) Record check results
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Drivers license/s (copies)
25
Quality Survey
or mail or fax a copy of your homestudy to: Embryos Alive 7741 Pfeiffer Road Cincinnati, Ohio 45242-5020 Contact Us cell: 513-518-7006 office: 513-793-1593 fax:513-793-0052 P.O. Box 42841 Cincinnati, Ohio 45242-5020 www.embryosalive.com
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