WIC Interest Form
ALL CAREGIVERS ARE WELCOME! WIC gives you access to healthy food, nutrition education and breastfeeding guidance. If you’re pregnant, a caregiver, or a parent with a child under 5, you can get the right personalized support for you and your family! Fill out the form below if you think you might be interested in the WIC Program in Teton County, MT!
Your Name
First Name
Last Name
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How many children do you have under the age of 5 years?
Are you pregnant?
Yes
No
Are you a foster parent?
Yes
No
What is your approximate annual household income?
i.e. $50,000
How many people live in your household?
i.e. 6
Are you or your children currently enrolled in any of the following programs?
SNAP
Healthy Montana Kids Plus and/or Montana Medicaid
TANF
FDPIR
National School Lunch Program (NSLP)
Not enrolled in any of the programs above
This institution is an equal opportunity provider.
Submit
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