WIC Pre-Application Information Online

Please fill in the blanks and select the appropriate answer to assist in making your application. Click SUBMIT and someone will contact you. Thank you!

All fields marked with an asterisk are required, and must be filled in.

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Last: *

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Preferred Language: *


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Address Line 2:
State / Province / Region:
Postal / Zip Code:

Address Line 2:
State / Province / Region:
Postal / Zip Code:

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Additional Applicants
(Pregnant, breastfeeding, or postpartum woman, and children in the home under the age of 5 years) :

Name of Person #1

Last:

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Name of Person #2

Last:

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Name of Person #3

Last:

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Background Information

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If YES, when?

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If YES, where? When?

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Email:

 

Contact Information


Text: (888) 413-8165
Phone: (209) 558-7377
Breastfeeding Helpline: (209) 525-4838

WIC Offices & Hours

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