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Are you interested in newly applying to the WIC program? Simply complete the form below to start the application process. A WIC representative will contact you by email within 24 hours during work weekdays. This does not guarantee your enrollment into the WIC program.

What is your family size? If pregnant, please include pregnancy. For example: Pregnant woman with a single unborn child are counted as two (2) in the family. Pregnant woman with two unborn children (twins) are counted as three (3).
Your gross household income for the last 30 days (before taxes and deductions).
Have you ever applied for WIC in this county or another county? Have you applied to WIC in a different state? If so, where and when?
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