Start the Sperm Donor Application Process

Please complete a short medical history screening to begin the process of becoming a Cryobank America sperm donor and earn up to $1000/mo.

How old are you?

years old

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your age precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Height

Feet

Inches

Height in cm

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your height precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Have you ever been convicted of a misdemeanor or felony?

No, I have never been convicted of either a misdemeanor or a felony.

Yes, I have been convicted of a misdemeanor.

Yes, I have been convicted of a felony.

Yes, I have been convicted of both a misdemeanor and a felony.

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your felony conviction precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Do you live within 50 miles of Cryobank America's facility located at 3050 S Center St., Suite 100, Arlington, TX 76014?

Yes

No

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your distance from our office precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Did you graduate from high school?

Yes

No

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your educational history precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Are you currently enrolled in or have previously been enrolled in an undergraduate, graduate, or professional degree?

Yes

No

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your educational history precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Are you or your parents adopted?

Yes

No

Are you able to provide 3 generations of medical history for biological parents?

Yes

No

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your adoption status and inability to provide 3 generations of medical history for biological parents preclude you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

Have you ever participated in a semen donor program at any other sperm bank/tissue bank/ and/or cryobank

Yes

No

Thank you for your interest in joining the Cryobank America Donor Program. Unfortunately, your participation with another sperm bank precludes you from participating in this program. If you think you have made a mistake in filling out this application, please use the Back button or start the application again.

If you would like to learn more about the requirements for becoming a Cryobank America Donor, please view our donor qualifications and incentives.

First Name

Middle Name

Last Name

Date of Birth

Weight

lbs

Eye Color

Natural Hair Color

Hair Texture

Email

Phone/Mobile

Cryobank America currently only allows applications from potential donors who live and/or reside in the U.S. or Canada

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Education & Occupation

Are you currently a student?

Yes

No

How many years of college have you completed?

Highest Education Level Completed?

Other Education Level

List of ALL college(s) attended

Major / Field of Study

What is your current occupation?

Other Occupation

Are you a citizen of the United States?

Yes

No

Ancestry & Ethnicity

Please indicate the ancestry/ethnicity.

Mother Ethnic Background

Father Ethnic Background

Blood Relatives

Please indicate the number of blood relatives that you have in each of the following categories (include full relatives, half-siblings, half-aunts, half-uncles, and those relatives that are deceased)

Sisters

Brothers

Maternal Aunts

Maternal Uncles

Paternal Aunts

Paternal Uncles

Other

Were you referred by an existing/former Cryobank America donor?

Yes

No

If yes, by whom?

Where did you hear about us?

If you selected Sponsored Event, which one?

Other Source

Lab Location

Number of hours since last ejaculation?

I understand that I will not receive compensation for this visit or possible semen analysis re-tests. After full qualification and admission into the Cryobank America Sperm Donor Program, my semen donations will be utilized for purposes of assisted reproductive technology procedures and/or any other means necessitated by Cryobank America, LLC.

The responses provided by me are accurate and true to the best of my knowledge. I agree to have Cryobank America, LLC use this application and my provided semen donation for analysis and review of qualification for admittance into the Cryobank America Sperm Donor Program.

Please only click the submit button once and wait for your form to submit. Do not click multiple times or your form will have multiple submissions. Thanks!

Potential Donor Signature

Date