Step 1 Application Process Checklist
To have your profile submitted to a donor and be considered for any embryos
first submit
step (1) one checklist
(contact us for the packets of the most up to date version and Step
1 and 2 Checklists)
embryosalive@yahoo.com
|
Application/Fee (prior to submission of your profile to a donor) |
|
*
Disclaimer/Fee/Disclaimer Contract prior to submission of your
profile
to a donor
* you and spouse- if applicable- may notarize separately
(there are 2 notary spots) |
|
Dear Genetic Parent/s Letter |
|
Profile,
photos or collage of family-extended family, inside and outside
of home, and any pets about 6-8 jpg email or mail |
|
Process
Pre and Post FDA May 25, 2005 |
|
Release of Information |
-
|
Disclosure |
|
*Match Contract
*(due within 48 hours of match and acceptance of match) so be sure
before you apply and accept-there are no refunds for any fees
**( A and R is not sent to donors until these items are in E.A.
office)
***
you and spouse- if applicable- may notarize separately (there
are 2 notary
spots) |
*
Mail, scan, or fax: 1. completed application, 2.
disclaimer, 3. release of information 4. disclosure 5. fees
(PayPal
embryosalive@yahoo.com add 10.00 to pick up)
EmbryosAlive@yahoo.com Fax: 513-793-0052
or 727-489-2427
Step 2
Checklist Dossier:
If you
have a current home study, mail or fax a copy to Embryos Alive 7741
Pfeiffer Road, Cincinnati, Ohio 45242-5020 Fax 727-489-2427
·
If you
do not have a current or pending approved homestudy, please
provide the following dossier or documents in order to complete and
process a match.
|
 9b
|
Compile,
organize by corresponding number, and use either sticky notes or
numbers on each document. |
|
10 |
Letter of
Understanding of Process |
|
11 |
Physician's letter
(stating you could carry a child to term) |
|
12 |
Criminal
History (webcheck) |
|
13 |
Affidavit
of Criminal History |
|
14 |
Embryo
Agreement and relinquishment (email us) (A and R)
*
you and spouse- if applicable- may notarize separately (there
are 2 notary spots) |
|
15 |
4
References (non-relative) |
|
16 |
Proof of
income (pay stub/current income tax/employer letter) |
|
17 |
Protocol
awareness letter (thawing protocol may not be available) |
|
18 |
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/Department of Motor Vehicles)
history |
|
23 |
Copy of
drivers license/s |
|
24 |
Sex Offender Clearance |
|
25 |
Counseling Awareness Letter |
|
26 |
Quality
Survey |
Email, 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
