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WIC Pre-Application Form

We look forward to working with you!

To get started, please fill out the form below.

WIC Pre-Application Form
Name
Name
Applicant's Information
Applicant's Address
Applicant's Address
City
State/Province
Zip/Postal
Country
Mother's Status
Do you have infants or children under the age of 5? *
Do You Need Additional Help?
We all know that babies don’t come with directions. Could you use the help and support of your own free personal nurse or case manager? Are you in need of help with housing issues or income support? Does your infant have a safe place to sleep? Are you interested in hearing about free classes for new moms and families? The Foundation for Delaware County offers free personal case managers or nurses for pregnant women and new parents. They can help you to connect to community resources and provide parenting education and ongoing support until your child turns 18 months or two years old."By clicking below, I do/do not give the Foundation for Delaware County WIC Program permission to share my contact information with the Foundation’s Healthy Start and/or Nurse-Family Partnership. I understand that a nurse or case manager will contact me via telephone or email soon to share more information and see if Healthy Start or Nurse-Family Partnership is a good fit for me and my baby."