Milk Bank WGL Donor Interest Form
Thank you for interest in milk donation!

In order to become a donor, we ask that you:

*** 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 mother, we are honored accept your donation of any size)

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

Our screening process consists of 4 steps:

1. Complete the donor interest form. We will call 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 will arrange for blood testing at no cost to you.
4. We will work with you to find a convenient depot to drop off your frozen breast milk or find other shipping/transport options.
Email address *
First Name *
Last Name *
Phone Number *
Please provide a 10 digit phone number in the format 999-999-9999
City *
State *
Zip Code *
How did you hear about us?
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