City of Meriden, CT WIC Application

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Fill out this application to apply for the WIC program through the City of Meriden, CT. We will reach out to you during our business hours to schedule an appointment.

Email *

Have you ever applied for WIC before? *

Yes

Have you ever received WIC in another state? *

Yes

If yes, please provide the state, city/town, and phone number of the WIC office where you previously received benefits.

Your answer

What is your first and last name?

Your answer

What is your date of birth *

YYYY

What is your street address? (If you do not have housing, please answer "N/A" *

What is your mailing address if different than your street address?

Are you currently pregnant? *

Yes

Are you a foster parent? *

Yes

Do you have any children under the age of 5? *

Yes

Provide first and last names and dates of birth for any child under five in your family or care:

What is your household income? *

Does your family receive family assistance from any of the following? Check all that apply *

Husky A / Medicaid

SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

TFA

Other:

Required

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