Louisiana WIC Pre-Application Survey

Thank you for your interest in the Louisiana WIC Program.

Did you know that Louisiana WIC now uses the WIC-EBT card which is much easier than paper vouchers? We have just a few questions to ask to screen you for the residency, income and other requirements of the program.

If you receive Louisiana SNAP benefits or you are a pregnant woman on Louisiana Medicaid or have an infant on Louisiana Medicaid, you automatically meet the income requirements for Louisiana WIC.

Before you can receive a WIC-EBT card in person, you will need to bring your and your children's ID, proof of income/Medicaid/SNAP card to the WIC office or upload them into the WIC Gateway, which is like a patient portal. Completing this pre-screening survey is completely voluntary and is not required to receive WIC services.

If you know what clinic you want to attend, it may help clinic staff call you back sooner. You can pull up a regional map to find locations near you on this link: https://louisianawic.org/find/

Question Title

* 1. Louisiana WIC is for residents of Louisiana. Check the box below that describes you and your family.

We live in Louisiana

We will be moving to Louisiana soon

I don't know

Question Title

* 2. Louisiana WIC is for pregnant women, women who have had a baby in the last 6 months, breastfeeding women, infants, children up to 5 years old and foster infants and children up to 5 years old.

Do you have someone in your household that fits on of these groups?

Yes

Question Title

* 3. Do you or anyone in your household currently receive Louisiana Medicaid, Louisiana SNAP (food stamps) or TANF?

Yes

I am not sure

Louisiana WIC Pre-Application Survey

Thank you for your interest in the Louisiana WIC Program.

Question Title

* 1. Louisiana WIC is for residents of Louisiana. Check the box below that describes you and your family.

Question Title

* 2. Louisiana WIC is for pregnant women, women who have had a baby in the last 6 months, breastfeeding women, infants, children up to 5 years old and foster infants and children up to 5 years old. Do you have someone in your household that fits on of these groups?

Question Title

* 3. Do you or anyone in your household currently receive Louisiana Medicaid, Louisiana SNAP (food stamps) or TANF?

* 2. Louisiana WIC is for pregnant women, women who have had a baby in the last 6 months, breastfeeding women, infants, children up to 5 years old and foster infants and children up to 5 years old.

Do you have someone in your household that fits on of these groups?