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Open and Print WIC Application Forms

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Instructions

  1. Open, print and complete the necessary forms. These are listed below.
  2. Call the WIC clinic nearest to you and let them know you want to apply and that you have completed the application forms. Click here for more information.
  3. Attend your appointment, and make sure you have everything you need.

 

1. Download, Print and Complete Forms

The forms listed below are PDF files. You should be able to click on them and save or print them. If you need the free Adobe reader, please click on the Adobe icon

Form Name

Do I need this form?

Family Information Complete one form for the whole family.
Pregnant Women Application
Complete one form for every pregnant woman in the family.
Postpartum/Breastfeeding Application Form
Complete for a woman who has a baby (less than six months old) taking formula or a woman who is breastfeeding a baby (that is less than one year old).
Infant Application Form
Complete one for every infant in the family, age birth to one-year-old.
Child Application Form
Complete one for every child in the family who is one-year to five-years-old.

 

2. Call the WIC Clinic Nearest To You.

Call the clinic to let them know you want to apply and that you have completed the application forms. The WIC staff will let you know what to do with the application. If you live in a town that has a WIC office, you will be given an appointment or information about walk-in hours. If you live in a town that does not have a WIC clinic, your application will be processed by mail. Click here for a list of clinics.

 

3. Things to Bring to Your First Appointment

Please bring the following to your WIC appointment:
  • Completed application forms.
  • Proof of income for yourself and child. Samples of proof of income are Medicaid/Denali Kid Care card, pay stub, letter from employer.
  • Proof of identification. Samples of identification are driver's license, passport, birth certificate, social security card, immunization record.
  • Each infant/child you are applying for as we will take their height and weight.
  • Proof of Pregnancy if you are pregnant.
  • Immunization cards for each child

 

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To address technical problems or make suggestions regarding this site, please email:
wic@alaska.gov

Other contact information:
Family Nutrition Services State of Alaska/DHSS/DPA
Address:

130 Seward St
PO Box 110612
Juneau, AK 99801

Main office:
Fax:

(907) 465-3100
(907) 465-3416

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