Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Women, Infants, and Children (WIC) Application

  1. Sherburne County: Women Infants and Children (WIC) Application

    Must reside in Sherburne County to complete this form. If you live outside of Sherburne County, apply thru MDH: MDH WIC Apply Online

  2. This is my*
  3. Can we text you at this number? *
  4. You, the Applicant are the:*
  5. Gender*
  6. Primary Language*
  7. Have you been on WIC before?*
  8. Financial Information

    People in same household, related or non-related, that share in financial and consumption of the same goods and services. 

  9. Are you or any member of your family on MA or MN Care? *
  10. Are you or any of your family members on any of the following programs?
  11. Reported Income
  12. If no income, put 0

  13. Extra Income*
  14. Extra Income
  15. Do you receive any of the following sources
  16. Please complete for pregnant or postpartum mom, or children under the age of 5.
  17. Breastfeeding?
  18. Certification*

    I certify that the information I have provided is correct to the best of my knowledge. I understand that intentionally giving false or misleading information will result in my not receiving WIC benefits.

  19. Leave This Blank:

  20. This field is not part of the form submission.