Milk Bank WGL Donor Interest Form
In order to become a donor, we ask that you:

A. Are able to donate at least 100 ounces of milk to our milk bank so that we may provide it to premature and ill babies in the region. (If you are a bereaved parent, we are honored accept your donation of any size)

B. Are willing to undergo a confidential health history screening and obtain a free blood test for communicable diseases.

The screening process consists of 4 steps:

1. After you complete the donor interest form below, we will contact you to complete a 10-15 minute pre-screening.
2. If you are a candidate for donation, we will email you the full donor application to complete.
3  We will review your completed application and contact your medical providers. Then we will arrange for blood testing at no cost to you.
4. We'll work with you to find a convenient depot to drop off your milk or find other shipping options.  

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Email *
First Name *
Last Name *
Phone Number *
What is the best number to call you for your phone screening? Provide in the format 999-999-9999
Milk Status
Give your best guess on approximately how much milk you currently have to donate. (There are no wrong answers!)
How did you hear about us?
Why are you donating milk? *
What is the main reason you are choosing to donate milk?
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