Online Application

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Please correct the field(s) marked in red below:

Thank you for your interest in the WIC program. To apply for WIC, please fill out the online application below.

1
Have you ever applied or been on WIC in the past?
Have you ever applied or been on WIC in the past?
2
How did you hear about the WIC program?
How did you hear about the WIC program?
3
Guardian's First and Last Name:
 *
4

Guardian's Date of Birth:

 *
5
 Street Address:
6
What county do you live in:
 *
7
Phone number:
 *
8
Email Address:
 *
9

Do you have a physical or language challenge?

Do you have a physical or language challenge?
10

If Yes to above questions, please indicate need.