Privacy Policy Donor-conceived adults interested in requesting their donor's identity should complete the form below. If your donor is in the Identity-Release® Program, he has agreed to provide the following information about himself: Name Date & place of birth Last known contact information When TSBC contacts the donor to prepare for information-releases, he is given the option to provide updated medical and contact information, information about him and his family, a photo and whether or not he is open to being contacted by donor-conceived adults. Please consider the possibility that: some but not all donors provide this updated information some but not all donors are open to being contacted After we receive your initial request form, we will match it with our records. Then Executive Director, Alice Ruby, will contact you to explain the process, answer your questions, and send you the necessary request forms. You may also email or call her at 510.841.1858 ext. 204. Your Contact Info First Name * Last Name * Street Address City State Zipcode Email * Phone Additional Information Your Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Your Donor's Number Your Family's Information Birth Parent's First Name Birth Parent's Last Name First Name of Additional Parent on File Last Name of Additional Parent on File Parental Street Address City State Zipcode Email Phone * Sibling* 1 First & Last Name *List siblings in your own family, not people who share your donor but were raised by other parents. Sibling 1 Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Sibling 1 Donor's Number Sibling 2 First & Last Name Sibling 2 Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019 Sibling 2 Donor's Number Do you have any other siblings? Yes No Comments We will be in contact soon. Thank you for your interest!
