Want to see if you qualify for WIC? Fill out this short form. Then our staff will call you back.

Complete this form and someone from a nearby WIC clinic will contact you. They will ask you questions to see if anyone in your home qualifies for WIC. Then they will schedule you an appointment for an in-person application. If your application is approved, you will receive WIC benefits the same day.

You can also call a WIC clinic directly for an appointment. Check out this map to find a clinic near you.

WIC provides food benefits and nutrition education to its participants.

Infants and children up to age 5 can receive WIC — so can women who are or were recently pregnant.

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* 1. What is your ZIP code?

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* 2. What is your first name?

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* 3. What is your last name?

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* 4. Please provide your phone number.

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* 5. Please provide an email address in case we can't reach you by phone.

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* 6. Do any of the following apply to you or anyone living in your home?

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* 7. Has anyone in your home ever received WIC in Louisiana?

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* 8. What is your preferred language?

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