Donor Form

All donor application forms must be complete and signed where indicated.

Some of the forms will require signatures witnessed by two people or a Notary Public.

Mail all pages of the completed forms to:

form

David Geffen School of Medicine at UCLA Donated Body Program
10833 Le Conte Ave., Room 14-143 CHS
Los Angeles, CA 90095-7340

You can also fax forms to (310) 794-0334.

Once the forms have been reviewed and accepted, an acknowledgement will be sent along with a donor identification card and two copies for retention. Please feel welcome to call the Donated Body Program at (310) 794-0372 for questions or assistance in completing the forms. All information provided will remain confidential to the extent allowed by law.

Before filling out the forms, please read this important information.

There are several reasons why an anatomical gift might not be suitable for study; anything that destroys or distorts the normal anatomy of the body extensively can make it difficult to conduct meaningful anatomical study. Some examples of conditions that make anatomical study difficult are:

  • An autopsy that has been performed
  • Serious injury or trauma
  • Infection Precautions- including HIV, Hepatitis, Tuberculosis, CJD and MRSA.
  • Recent extensive surgery (this does not mean that individuals that have had surgery are automatically disqualified);
  • Advanced muscular atrophy;
  • Donations of organs to other programs;
  • Weight in excess of 250 lbs.;
  • Bodies arriving more than 24 hours from time of death;
  • Advanced decomposition.

The Donated Body Program reserves the right to decline or accept the donation of an anatomical gift as set forth by health and safety code §7154 (a).

adobe logo

Acrobat® Reader® is required to view these files. If you do not already have it, a free copy can be downloaded here:

Download and Print Donor Form (PDF)