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Do you live in one of these California cities or South Los Angeles?

South Los Angeles, Bell, Bell Gardens, Compton, Cudahy, Downey, Huntington Park, Lynwood, Maywood, Paramount, South Gate, Vernon

If you do not live in one of these cities, do not continue. Instead phone (916) 928-8806 or go to wicworks.ca.gov for more information. If you have a mobile phone, you can go to https://m.wic.ca.gov/

If you do live in one of these cities, please complete this form. A WIC representative will contact you soon. She or he will answer all your questions.

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Your first name (required)*
Your last name (required)*
Phone number with area code (required)*
What kind of phone is this?
- A cell phone
- A landline
A second phone number with area code
What kind of phone is this?
- A cell phone
- A landline
Address
Your address City State ZIP Code
Email address
What is the best way to reach you?
- By cell phone
- By landline
What is the best time to reach you?
- 8:00 a.m. - noon (morning)
- noon - 4 p.m. (afternoon)
- 4 p.m. - 8 p.m. (evening)
Do you want to write a message?

Do you have questions about this form? Phone (310) 661-3080

Apply Today

Your first name (required)*
Your last name (required)*
Phone number with area code (required)*
What kind of phone is this?
A cell phone
A landline
A second phone number with area code
What kind of phone is this?
A cell phone
A landline
Address
Your address City State ZIP Code

Email address

What is the best way to reach you?
By cell phone
By landline
What is the best time to reach you?
8:00 a.m. - noon (morning)
noon - 4 p.m. (afternoon)
4 p.m. - 8 p.m. (evening)
Do you want to write a message?

Do you have questions about this form? Phone (310) 661-3080

¡Solicite sus beneficios hoy!

¿Tiene usted preguntas acerca de esta forma? Teléfono (310) 661-3080.