Application The WIC application has two parts: Part One: Application supplied by the family
Part Two: Information from a recent medical check-up supplied by the doctor. Print out the form you need below, and take it with you to your doctor.
To apply for WIC
- Complete one application in the preferred language for the FAMILY
- Print one Medical Referral for EACH child or woman applying for WIC (all medical referrals are in ENGLISH only).
- Note: Print the appropriate Medical Referral for each applicant. There is one for Children/Infants, Women who are Pregnant and a different one for Women who have delivered their infant.
- Make an appointment with CHDP for a Well Child Check-Up or a prenatal appointment. Take the correct Medical Referral form listed above with you, for your doctor to complete.
- If you or your child child recently had an exam, your doctor may write those results on the Medical Referral. If you are due for another appointment or for immunizations, your doctor may want to schedule an appointment before completing the referral.
- Submit one completed application through E-Mail by using the provided form.
- Bring the Medical Referral for each applicant to the initial WIC appointment.
For assistance or further information
Call WIC at: 805-981-5251 or toll free 800-781-4449 x3
E-Mail/Text Message to: email@example.com
What happens next
Applications are reviewed and potentially eligible families are given an appointment at the nearest WIC site. WIC will verify families' documents for eligibility at the first WIC appointment. Qualifying new participants will receive an orientation, individual nutrition counseling and food checks at this appointment.
"In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director , Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call 800-795-3272 (voice) or 202-720-6382 (TTY). USDA is an equal opportunity provider and employer."