Agency Partner Application

Section 1: Organization Information

Basic details about your organization and where to reach you.

Your Position

Website

Organization Type

Primary Point of Contact (Agency Admin)

This is the person who will serve as your agency's point person and admin on the Make Families platform. They will be responsible for adding a payment method for reservations and managing the agency's portal access. Make sure this person has the authority to set up billing on behalf of the agency.

Agency Admin — Full Name *

Agency Admin — Email *

Additional Team Members

Add up to three additional staff members who should have portal access. Team members can make reservations and upload candidates on behalf of your agency. (Optional — leave blank if not applicable.)

Team Member 1

Full Name

Team Member 2

Full Name

Team Member 3

Full Name

Address

Street Address

City

State

Zip

Country

Does your organization have multiple locations? If so, list the other cities you are located in.

Section 3: Tell Us About Your Intended Parents

Help us understand the IP population you typically serve.

What percentage of your IPs are international?

Do you predominately match with IPs in certain countries? If so, which countries?

Please estimate what percentage of your IPs are same-sex.

Please estimate what percentage of your IPs identify as pro-life or no-term.

Please estimate what percentage of your IPs live in Southern or conservative States such as Texas or Alabama.

Do you match surrogates who are no-term?

Yes No Occasionally

Section 4: Tell Us More About Your Program

Walk us through how your program operates day-to-day.

How does your program work?

Describe your team and structure.

How many cases do your case managers manage at any given time?

Escrow & Legal

Does the organization hold escrow for clients?

Yes No

How is escrow managed?

Does the organization have in-house legal representation for IPs or surrogates?

Yes No

Section 5: Legal & Compliance

Disclosures regarding licensure history, legal matters, and any criminal background.

Has any owner been disciplined by any state/federal licensing board?

Yes No

Has the owner been involved in any legal issues or currently involved in any lawsuit? (Excludes traffic tickets.)

Yes No

Do you currently have any criminal action pending against you?

Yes No

Have you ever been charged with or convicted of a felony?

Yes No

Section 6: Agency Practices

Tell us about your matching, screening, and clinical processes.

Screening & Records

How does your organization manage mental health screening?

How does your organization manage medical record collection?

Does your organization match before submitting medical records to the fertility clinic for review?

Matching

Does your organization allow surrogates to choose their IPs?

Yes No

Please explain your matching process.

Does your organization facilitate match calls and stay on the video call the entire time?

Yes No

Surrogate Compensation

Typical surrogate base fee range — first-time

Typical surrogate base fee range — experienced

Do you allow your surrogates to request their own base fee or change their benefits package?

Yes No

Geography & Embryos

Do you match in certain areas of the US more than others? If so, where?

Do you match surrogates to Intended Parents before the parents have embryos ready?

Yes No

Do you report the quality of embryos to your surrogates when they are considering a match (tested, mosaic, etc.)?

List the top 5 fertility clinics you work with most often.

Re-matches & Wait Times

How often are you able to re-match surrogates who have had two or more failed transfers?

Do you require a certain amount of wait time before matching a surrogate who needs to remove an IUD or Nexplanon?

Do you match surrogates while they are still breastfeeding?

How long do you require surrogates to wait post-partum before matching them for another pregnancy?

Section 7: Introduction & Certification

Almost done — just one final question and the certification.

Please write an introduction email as if you were writing to a potential surrogate explaining what is special about your agency and why they should work with you.

Certification & Consent

I certify that the information contained in this application is true, accurate, complete and correct. I understand that any false or misleading statements may result in the rejection of this application or removal of our agency from the Make Families partner network. I furthermore consent to receiving emails and SMS messages from the Make Families team regarding this application.

Agency Partner Application

Let's get started

Section 1: Organization Information

Section 2: Reasons for Applying

Section 3: Tell Us About Your Intended Parents

Section 4: Tell Us More About Your Program

Section 5: Legal & Compliance

Section 6: Agency Practices

Section 7: Introduction & Certification

Application Submitted!

Agency Partner Application

Let's get started

Section 1: Organization Information

Section 2: Reasons for Applying

Section 3: Tell Us About Your Intended Parents

Section 4: Tell Us More About Your Program

Section 5: Legal & Compliance

Section 6: Agency Practices

Section 7: Introduction & Certification

Application Submitted!

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