WIC Pre-Application

Thank you for your interest in the Women, Infants and Children (WIC) Program! You can get started online by completing this pre-application. Your information is securely sent to the local WIC agency in your county and a WIC staff member will contact you to answer your questions and to schedule an appointment. Please see the income guidelines on this website. Completing this pre-application does not guarantee your enrollment in the program, because your eligibility will be determined at your first WIC appointment. Please submit your pre-application today!

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Contact Information



















Appointment Preference
Application Status
Who is applying for benefits?

Mother's Information




Mother's status



Mother's Race




Mother's Ethnicity
Medical Assistance

The collection of race & ethnicity information is strictly for statistical reporting requirements and has no effect on the determination of eligibility to participate in the WIC program.

Child Information

To add a child to the list below, enter the following information and click or press "ADD CHILD"





Child's Race



Child's Ethnicity
Medical Assistance

The collection of race & ethnicity information is strictly for statistical reporting requirements and has no effect on the determination of eligibility to participate in the WIC program.

You MUST bring the following items to your appointment:

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  • Proof of identity, for example:
    • For a woman – driver’s license, photo ID card, passport or student ID
    • For an infant – birth certificate, crib card or discharge paperwork
    • For a child – birth certificate, crib card or passport
  • Proof of all sources of income for everyone living in the household (ex. pay stubs for the last 30 days, unemployment letter, child support, income tax return for self-employed persons only)
  • ACCESS card (if applicable)
  • Proof of Pennsylvania residency (document with name and current address such as driver’s license, utility bill or recent mail)
  • Immunization record for all children under 2 years old (ex. baby book, health passport), if available
  • Your child(ren) under age 5
  • Proof of pregnancy stating due date (if applicable)