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Fill out the form below with your information and the best way to reach you. A WIC staff member will be in touch within a few days to schedule your appointment.

To find contact information for your local WIC clinic, please visit: https://doh.sd.gov/topics/children-s-health/community-health-offices/ 

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* 1. First Name:

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* 2. Last Name:

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* 3. Email:

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* 4. Phone Number:

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* 5. Is it okay to text you?

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* 6. If it is okay to text you, who is your cell phone provider?

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* 7. Primary Language:

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* 8. Need interpreter? 

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* 9. When is the best time to reach you?

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* 10. What is the best way for WIC to contact you?

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* 11. Which of the following programs do you participate in? 

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* 12. I am applying to WIC because I am/have (select all that apply):

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* 13. Please enter your zip code:

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* 14. How did you hear about WIC?

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* 15. SD WIC is looking for people to participate in a focus group or survey. Would you be interested in this opportunity? Clicking "No" will not prevent you from receiving WIC services.

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