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 May 1, 2026 - June 30, 2027
Number of persons in Family Unit ** Annual Monthly

Twice Monthly
(Semi-Monthly)

 Bi-weekly Weekly
1 $29,526 $2,461 $1,231 $1,136 $568
2 $40,034 $3,337 $1,669 $1,540 $770
3 $50,542 $4,212 $2,106 $1,944 $972
4 $61,050 $5,088 $2,544 $2,349 $1,175
5 $71,558 $5,964 $2,982 $2,753 $1,377
6 $82,066 $6,839 $3,420 $3,157 $1,579
7 $92,574 $7,715 $3,858 $3,561 $1,781
8 $103,082 $8,591 $4,296 $3,965 $1,983
Each add’l family member add $10,508 per added family member $876 per added family member $438 per added family member $405 per added family member $203 per added family member

**A pregnant applicant’s unborn embryo(s) or fetus(es) may be counted as part of the household size if the applicant does not meet income eligibility requirements at the current household size. The addition of unborn embryo(s) or fetus(es), for purposes of calculating income eligibility, should be offered to the pregnant applicant as an option. The unborn embryos(s)/fetus(es) should not be automatically added to household size.
Families who receive Medi-Cal/Medicaid, CalFresh/SNAP, or CalWorks may qualify. 

1. What would you like to do? *


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


3. Is this a foster family? *


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?


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


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


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