Apply for WIC - Central District Health

Please note: This online WIC application is only for Ada County, Boise County, Elmore County, and Valley County.

WIC is an equal opportunity provider. For the full nondiscrimination statement and contact information to file a complaint, please visit the Idaho WIC website at www.wic.dhw.idaho.gov.

Contact Information

First Name *

Middle Name

Last Name *

Date of Birth

Interpreter Needed

Yes

Language Language

Applicant Information

How many people are living in your household? (include unborn children)

Is anyone in your household receiving SNAP, TANF, Medicaid or CHIP?

Yes

What is the highest grade you have completed in school? What is the highest grade you have completed in school?

Is anyone in your household a migrant worker?

(Employment is agricultural on a seasonal basis which requires you to live away from your primary home)

Yes

Where did you hear about WIC? Where did you hear about WIC?

Which WIC office would you like to receive services in?

Would you like to add an additional applicant?

Yes

Proof of Physical Address, Proof of Income

Required Documents

The following are required documents for your appointment. If you wish, you may attach them here in advance of your appointment.

* Proof of physical address. (No P.O. Boxes)
* Proof of income for the last 30 days unless you are on Medicaid, CHIP, TANF or SNAP.

How will you provide these documents to WIC? How will you provide these documents to WIC?

Proof of Physical Address, Proof of Income Attachments

Maximum file size: 268.44MB

Would you like to add a second cardholder?

(Someone else that could shop at the grocery store for WIC items and attend appointments)

Yes

Second Cardholder

First Name *

Last Name *

Date of Birth

Phone

Mailing address is the same as contact address?

Yes

Mailing Address

Mailing Zip

Mailing City

If you are human, leave this field blank.

Apply for Women, Infants, Children (WIC)

Idaho WIC Program Application

Contact Information

Contact Address Details

Contact Details

Applicant Information

Proof of Physical Address, Proof of Income

Individuals Who Are Applying For WIC Services

Second Cardholder