Get Wic Application

The WIC application is essential for participating in the Women, Infants, and Children (WIC) program, providing access to vital nutritional resources. This guide will help you navigate the process of completing the application online, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to complete the WIC application online.

1. Press the ‘Get Form’ button to acquire the WIC application form and open it in your chosen editor.
2. Begin by filling out the general information section, which includes your name, date of exam, and date of birth. Ensure that all details are accurate.
3. Provide the mother’s name and phone number, selecting the preferred contact number type (home, cell, or work). Include her date of birth.
4. Indicate your current weight and circle either lbs or kg based on the measurement you've provided. Also, document your pregnancy weight gain in the same manner.
5. Complete the address section with your full address, including city and ZIP code.
6. Fill in the number of weeks you are currently gestating and your expected due date.
7. If applicable, provide your Medicaid number.
8. Indicate the number of individuals living in your household and the total number of pregnancies.
9. Fill out the gross income of your household, specifying if it is weekly, monthly, or annually.
10. Mark any assistance you currently receive, such as Food Stamps or Medicaid, and specify your race and ethnicity.
11. If applicable, provide any medical concerns or special dietary needs that your healthcare provider may assist with.
12. For each infant or child under the age of 5, provide their name and date of birth. If you have more than three children, use a second form.
13. Sign the form where indicated and include the date. You may also need a signature from your healthcare provider for certain sections.
14. After completing the form, save your changes, and choose to download, print, or share the application as needed.

Complete your WIC application online today to gain access to essential nutritional support.