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 answer
Your Date of Birth *
MM
/
DD
/
YYYY
Cell Phone Number
Your answer
Home Phone Number
Your answer
Email
Your answer
What is your preferred method of communication? *
Address Street *
Your answer
City *
Your answer
Zip Code *
Your answer
County *
Your answer
Are you pregnant? *
Have you had a baby in the last 6 months? *
Number of children in the home under 5 years old? *
Your answer
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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