La Crosse County WIC Online Application
To find out if you qualify, complete this application and submit. Our WIC Program will be in touch with you.

If you do not hear from us within ten days, please call 608-785-9865.
Calls also welcome to ask about eligibility or to make an appointment.
Email: laxwic@lacrossecounty.org.
Address: La Crosse County WIC Program, 300 4th Street North, La Crosse, WI 54601.
https://www.getactivelacrosse.org/eat-healthy/women-infants-and-children/

USDA is an equal opportunity provider and employer.
Please find the full non-discrimination statement at:
https://www.dhs.wisconsin.gov/wic/non-discrimination.htm#english


Answer the following questions to the best of your knowledge. All information will be kept confidential.
Your First and Last Name *
Your Date of Birth *
MM
/
DD
/
YYYY
Cell Phone Number
Home Phone Number
Email
What is your preferred method of communication? *
Address Street *
City *
Zip Code *
County *
Are you pregnant? *
Have you had a baby in the last 6 months? *
Number of children in the home under 5 years old? *
What is the total number in the home? (including baby if pregnant) *
Is anyone in the home receiving BadgerCare?(used to screen for eligibility) *
What is the current household income? Enter dollar amount under "Other"(used to screen for eligibility) *
Required
Submit
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