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Women, Infants, and Children (WIC) Application

  1. WIC Application Form
    Only Chisago County residents may apply. For residents of other Minnesota counties, please call 1-800-942-4030.
  2. Contact Chisago County WIC at 651-213-5206 with any questions about your application.
  3. Remember to include area code
  4. People in the same household are related or non-related and share in consumption of the same goods and services. If you are applying for your foster children, each foster child is considered family of one. Pregnant women count as two. Include any children that you are paying child support for.
  5. Please list any household members who are pregnant or postpartum women and children under 5.
  6. Please check ALL services that the household receives:
  7. STOP: If Applicant is CURRENTLY receiving services listed above, you automatically qualify for WIC and do NOT need to fill out INCOME information.
  8. Financial Information: Please report gross income (before taxes)
    (Annual income based on federal tax forms: Form 1040 - line 11b)
  9. If no income, put 0
  10. Certification*
    I certify that the information I have provided is correct to the best of my knowledge. I understand that intentionally giving false or misleading information will result in my not receiving WIC benefits.
  11. Leave This Blank:

  12. This field is not part of the form submission.