Applications for Public Assistance

Use the links below to apply.

Mail, fax, drop off, or email your application. See our Contact Us webpage for more information.

Copies of applications are available at local offices, and we can mail one to you if asked.

An electronic application is not available for programs other than MAGI (income-based) Medicaid at this time.

Medicaid Applicants please note:

• Income-based Medicaid applicants are encouraged to apply at www.healthcare.gov. This is the fastest way to see if you’re covered.
• Older age or disability Medicaid applicants should only use the following (paper) application at this time:

Other Applications

• Senior Benefits Program: Application
  
• Heating Assistance Program: Application
  One benefit is issued per “season” which runs from October 1 through August 31. Outside those times, visit a local office for an application or ask the Heating Assistance Office at 1 (800) 470-3058 or liheap@alaska.gov.
• WIC (Women, Infants and Children) Program:
  Call the WIC clinic closest to you. You can find clinics near your location by entering your zip code on WIC Signup page or by selecting a clinic from our WIC Clinic contact information page.
  Download and complete the paper forms and call the WIC clinic closest to you. Paper forms include:
  
  • 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- to five-years-old.
  • Commodity Supplemental Food Program (CSFP) Application
    (CSFP) works to improve the health of seniors at least 60 years of age by supplementing their diets with nutritious USDA commodity foods.
• Child Care Program Office:
• Information for Families
• Service Delivery Areas (map)
• Child Care Assistance Contact Information
  Be sure to scroll down to the contact information that corresponds with the office located on the map.
  
• CC08 - Child Care Assistance Application
• CC24 - Health Status Report
• CC36 - Employment Statement
• CC37 - Family Report of Change
• CC38 - Monthly Tip Ledger
• CC39 - Self-Employment Income / Deduction Worksheet
Provider forms are available at the Child Care Services Forms section of the Child Care Program Office website.