Thank you for your interest!

Applications Are Currently Open
 
Have you submitted a contact form to us in the past? 
If you have completed a contact form in the past, our website will not allow you to save a new one. Please do not submit a new form with alternate contact information. Instead, email us at donorapplications@prolacta.com for instructions on moving forward.

Please Read Before Moving Forward: 
For your submission to be reviewed, your contact information below and the subsequent application must both be completed in their entirety. 

  • ​Completing the application may take approximately 45-60 minutes to complete. Ideally, it should be finished within one sitting; however, progress may be saved for up to 7 days. Applications not submitted within this timeframe will be removed from our system and a new application will be required if you return later.
  • Our application will ask for your healthcare provider and pediatrician’s contact information (name, phone, fax, email) and about your medical history. We recommend gathering the following information before you start your application: 
    • Contact information for both you and your baby’s healthcare providers.
    • Dates of vaccines you received within the last 12 months.
    • Dates of illnesses or medical procedures.
    • Labels for the medications and supplements you take on a regular basis.
  • You will not be required to provide copies of medical or vaccination records. 
  • At this time, we can only accept donations from individuals who reside in the US.  ​
Please note: Tiny Treasures donors are compensated $1.20/qualified ounce of milk they donate. Applicants must have a Social Security Number (SSN) or Individual Tax Payer Identification Number (ITIN) and are required to complete a W-9 form and direct deposit (ACH) form in order to become qualified and receive payment.

By completing this form, you are affirmatively and voluntarily providing your personal information to Prolacta so that we can potentially qualify you as a human milk donor. 

 

Thank you for helping babies like me!