Application | Gift of Surrogacy Foundation

Thank you for your interest in the Gift of Surrogacy Foundation grant. This application is very comprehensive and will require you to provide in-depth information about your financial and medical history, as well as forms that will need to be downloaded and filled out by a physician. We need all of this information to make the best possible decision, and we will treat it with the utmost confidence. Only those who are on our review committee will have access to this information.

The deadline to submit your application is August 31, 2024. We will try to make a decision within 6-8 weeks of the application deadline.

PLEASE READ:

Gift of Surrogacy Foundation acknowledges that some of the information and forms required to complete this application are sensitive medical and financial data. We take your privacy very seriously. Any sensitive data will be disclosed solely on a need-to-know basis, and everyone who has access will be required to sign a confidentiality agreement prior to review. Additionally, the platform used to administer this application is compliant with relevant regulation. Please feel free to reach out if you have any additional questions.

Eligibility Requirements

Please review these requirements carefully, because a failure to meet ANY of these requirements will result in an automatic denial of your application.

1. Surrogacy must be medically necessary (medical conditions listed here)

2. Citizen or legal, permanent resident of the United States (U.S.)

3. Resident of the State of Georgia

4. Embryos must be created (and frozen) by the time of application submission

5. A minimum of three euploid (genetically normal) embryos must be created

6. Surrogate agency and intended surrogate must reside in the U.S.

7. Frozen embryos must reside in the U.S

8. Additional Eligibility Requirements (listed here)

BY CLICKING THE "NEXT" BUTTON AT THE BOTTOM OF THE PAGE YOU CERTIFY THAT ALL APPLICANTS CURRENTLY SATISFY ALL OF THE ABOVE REQUIREMENTS OR HAVE AN APPROVED EXCEPTION*

*To apply for an exception, please email us at [email protected] prior to submitting application

Required Attachments

You will be able to upload the below required documents and responses as you go through the application.

Personal Statement: Help us get to know you and your situation. Do not include your name in the statement unless you are comfortable sharing your names with the Grant Review Committee. Personal statement should include the following (2 pages max, photos are allowed):

• Tell us about yourself

• Summary of medical need for surrogacy

• Any additional information you think we should know

Medical: Please have your Reproductive Endocrinologist (REI) complete and sign the medical form. Please allow sufficient time for your physician to complete these pages and return them to GSF.

Financial: Please attach all of the following:

• Gift of Surrogacy Foundation (GSF) Applicant Financials

• Last two (2) Federal income tax returns for each applicant

• Two (2) most recent pay stubs for each applicant

• Two (2) most recent Forms W-2 for each applicant

Applicant 1

First Name

Last Name

Please download these forms and complete prior to submitting the application.

GSF Applicant Financials. Download Here

REI Medical Form. Download Here (this form will be returned back to us directly from your REI)

Sex at birth

Preferred Gender

Date of Birth

Sun Mon Tue Wed Thu Fri Sat

Mailing Address

Mailing Address Line 2

City

State

Zip Code

Phone Number

Email Address

Relationship Status

Highest Degree Earned

Please provide your social media handles.

Facebook

Instagram

How did you hear about Gift of Surrogacy Foundation?