Teletask

WIC Application

Please provide the following information. If you are eligible, a WIC counselor will contact you to schedule an appointment.

**Gross Income**
185% Federal Poverty Level
Effective April 1, 2024 - June 30, 2025
Number of persons in Family Unit **	Annual	Monthly	Twice Monthly (Semi-Monthly)	Bi-weekly	Weekly
1	$27,861	$2,322	$1,161	$1,072	$536
2	$37,814	$3,152	$1,576	$1,455	$728
3	$47,767	$3,981	$1,991	$1,838	$919
4	$57,720	$4,810	$2,405	$2,220	$1,110
5	$67,673	$5,640	$2,820	$2,603	$1,302
6	$77,626	$6,469	$3,235	$2,986	$1,493
7	$87,579	$7,299	$3,650	$3,369	$1,685
8	$97,532	$8,128	$4,064	$3,752	$1,876
Each add’l family member add	$9,953 per added family member	$830 per added family member	$415 per added family member	$383 per added family member	$192 per added family member

**Unborn fetuses may be counted toward household size.
Families who receive Medi-Cal/Medicaid, CalFresh/SNAP, or CalWorks may qualify.

1. What would you like to do? *

Apply (new applicant)

Re-Apply (less than 2 years since last received WIC benefits)

Transfer to Stanislaus County from another county/state

Enroll newborn(s)

2. If you are a current WIC participant, please provide your family ID or WIC card #

3. Is this a foster family? *

Yes

No

4. If this is a referral, what agency are you referring from?

5. First Name *

6. Last Name *

7. Date of Birth (MM/DD/YYYY) *

8. Physical Address *

9. City *

10. Zip Code *

11. Phone Number (###) ###-##### *

12. Preferred Language *

13. Is an interpreter needed for appointments?

Yes

No

14. Are you (Check all that apply): *

Pregnant

Breastfeeding

Have child(ren) under the age of 5 years

Postpartum (had a pregnancy loss less than 6 months ago)

15. Are you currently receiving Medi-cal, TANF, or CalFresh? *

Yes

No

16. Which office would you like to go to? *