Milk Donor Interest Form 8.2024

Milk Donor Interest Form
Thank you for taking your first step toward becoming a lifesaving milk donor by completing the following brief questions. We are seeing a huge spike in need right now, so your help couldn’t come at a better time!
Your Name

First NameLast Name
Your Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Baby's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Thank you for your interest in becoming a milk donor – we are so grateful for your big heart!

We do not typically approve donors residing in your area due to the shipping costs associated with the distance. The good news is that there is another milk bank closer to you – please click here to find its website!

If there is a specific reason you strongly prefer to donate through our bank, such as having a connection to a hospital we serve or if you are a Deloitte employee interested in their LSHC Working Parent Initiative Collaboration, please let us know by emailing milkdonor@themilkbank.org!

Again, thank you for reaching out and we wish you the best!
Thank you for your interest in becoming a milk donor – we are so grateful for your big heart!

We do not typically approve donors residing in your area because there is a partner milk bank serving Illinois and Wisconsin – please click here to learn about donating through the Mothers' Milk Bank of the Western Great Lakes!

If there is a specific reason you strongly prefer to donate through our bank, such as having a connection to a hospital we serve or if you are a Deloitte employee interested in their LSHC Working Parent Initiative Collaboration, please let us know by emailing milkdonor@themilkbank.org!

Again, thank you for reaching out and we wish you the best!
Thank you for your interest in becoming a milk donor – we are so grateful for your big heart!

We do not typically approve donors residing in your area because there is a partner milk bank serving Oklahoma and Kansas – please click here to learn about donating through the Oklahoma Mothers' Milk Bank!

If there is a specific reason you strongly prefer to donate through our bank, such as having a connection to a hospital we serve or if you are a Deloitte employee interested in their LSHC Working Parent Initiative Collaboration, please let us know by emailing milkdonor@themilkbank.org!

Again, thank you for reaching out and we wish you the best!
Thank you for your interest in becoming a milk donor – we are so grateful for your big heart!

We do not typically approve donors residing in your area because there are partner milk banks serving New Jersey – please click here to find contact information for the one closest to you!

If there is a specific reason you strongly prefer to donate through our bank, such as having a connection to a hospital we serve or if you are a Deloitte employee interested in their LSHC Working Parent Initiative Collaboration, please let us know by emailing milkdonor@themilkbank.org!

Again, thank you for reaching out and we wish you the best!
Thank you for your interest in becoming a milk donor – we are so grateful for your big heart!

Just so you know, our bank primarily serves Indiana, Kentucky, and Missouri. If you'd like your milk to stay closer to home, please find your closest bank here. They may also have convenient drop-off sites near you.

If you'd like to continue the approval process with us, we'll be happy to work with you and provide free shipping supplies - please continue below if that's what you prefer!
How did you hear about us?
Help us get to know you! Which of the following is closest to the reason you’re exploring milk donation?
Are you ready and willing to make a donation of your human milk within 30 days from completing the approval process?
Are you able to complete a brief (5-15 min) online information form about your health, lifestyle, and medication history within the next week? You do NOT need to know your delivery meds.
After you submit the online information form, are you willing to complete a quick phone call (usually 5-10 minutes) so we can verify information, review next steps, and answer your questions?
Are you ready and willing to schedule and complete a blood draw, at no cost to you, within 2-3 weeks of your phone screen? We'll send you an order for the option that's most convenient for you.
We are truly so grateful that you took the time to find us and learn what our approval process involves! Based on your responses, it looks like you may have more questions or just need a bit more time before moving forward. We totally understand that there’s a lot on your plate right now, and that this is a deeply personal decision!

Our small but mighty team is working on getting lifesaving milk as quickly and safely as possible to babies in need, so we are prioritizing potential donors who can complete the approval process now and make their first donation within 30 days after approval. If we can answer any questions for you, please give us a call at 317-536-1670 or email milkdonor@themilkbank.org.

When you are ready to move forward in the future, please do come back and complete this form again to get started!

Please also keep in mind that there are plenty of ways to support The Milk Bank's lifesaving mission, aside from milk donation! Please consider engaging with us on socials (@TheMilkBank) to help raise awareness, subscribing to our newsletter, or giving financially if you're able. We are so appreciative of your generous spirit!
You have our deepest sympathies for your loss, and we’re honored to help support you as you navigate this difficult time – regardless of whether you end up donating or not.

If you’re sure you want to move forward with the milk donor approval process, please check the box below and click Submit; you’ll then be redirected to the next step in the process. We only ask that you wait until after delivery to complete that step, as much of the information needed will be unknown until then.

If you have questions before moving on to that step, please feel free to contact us at milkdonor@themilkbank.org or call us at 317-536-1670 and ask to speak with our Bereavement Coordinator. You can also click here to learn more about available supports, including around supporting or suppressing lactation.

Thank you for reaching out to explore the possibility of donating and our services.
Do you need an interpreter? (¿Necesita un intérprete?)
What is your preferred language? (¿Cual es su idioma preferido?)
Thank you for taking the time to complete this form! Once you hit the "Submit" button, you'll receive instructions regarding your next steps.
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