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WIC APPLICATION
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Name (your legal name)
*
First Name
Last Name
What is your date of birth?
*
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Has anyone in your household had WIC in the state of Montana before?
*
No
Yes
Are you homeless?
*
yes
no
Please describe where you are staying at night
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Are you pregnant?
*
yes
no
no; I had a miscarriage, pregnancy loss, or an infant loss in the last 6 months
Do you have any children under the age of 5 in your household?
*
yes
no
How many children under the age of 5 do you have in your household?
*
1
2
3
4
Other
Do you have any infants under 12 months old?
*
yes
no
Are you breastfeeding?
*
yes
no
What is your child's legal name?
*
First Name
Last Name
What is your child's birthday?
*
What is your second child's legal name?
*
First Name
Last Name
What is your second child's birthday?
*
What is your third child's legal name?
*
First Name
Last Name
What is your third child's birthday?
*
What is your fourth child's legal name?
*
First Name
Last Name
What is your fourth child's birthday?
*
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Do you or your children have Medicaid, SNAP, TANF, FDPIR, or free or reduced school lunch in the state of Montana?
*
No
Yes, Medicaid (or HMK Plus)
Yes, SNAP
Yes, TANF
Yes, FDPIR
Yes, free or reduced school lunch
I do not know
I applied for one of these programs, but I am still waiting to hear back
Did you recently have WIC in a different state?
yes
no
Find out if you may be Income Eligible for WIC
Click on the Income Eligibility Guidelines below. WIC uses the gross income (before taxes).
How do I know how many people are in my household?
A household for WIC is defined as a group of related or unrelated people who are living together as one economic unit (i.e. sharing the cost of rent, food, and/or utilities. Note: Please include your partner's income, even if you are NOT married, if they are sharing the cost of rent, food, and/or utilities Note: A pregnant woman can be counted as two people, which includes the unborn baby. If a pregnant woman is pregnant with twins, they can be counted as three people.
Does your household have zero income in the last 30 days?
*
Yes
No
To see if you may be income eligible for WIC, tell us about the gross income (before taxes) for your household for the last 30 days.
A household for WIC is defined as a group of related or unrelated people who are living together as one economic unit (i.e. sharing the cost of rent, food, and/or utilities. Note: A pregnant woman can be counted as two people, which includes the unborn baby. If a pregnant woman is pregnant with twins, they can be counted as three people.
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Please upload the following documents.
If you do not upload the documents before you submit this application, it may delay processing time.
UPLOAD YOUR IDENTIFICATION
We need one form of identification for you
File Upload
Browse Files
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Choose a file
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UPLOAD YOUR CHILD(REN)'S IDENTIFICATION
We need one form of identification for each child under age 5
File Upload
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Choose a file
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UPLOAD YOUR PROOF OF RESIDENCY
File Upload
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Choose a file
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UPLOAD YOUR PROOF OF INCOME
WIC uses the gross income (before taxes).
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
After you submit the application, WIC staff will process your application and contact you to schedule an appointment. You must complete an appointment before you can get on the WIC program.
Uploading all required documents may help speed up the application process, so please take the time to do that now.
By clicking the submit button, I agree that I have looked at the Income Eligibility Guidelines above and believe that my household income might qualify for WIC. WIC staff will review your application and contact you.
This institution is an equal opportunity provider.
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