How To Apply
1. Fill out a Texas Women's Health Program application form.
- Pick up a form at a clinic that offers these services. Fill out the one-page form at the clinic, and you might get services the same day.
- Download the form (English). This form is also available [en Español]. Fill out the form and send it in. See the mailing instructions below.
- Call the Texas Women's Health Program at 1-866-993-9972 (toll-free). We can take your call from 8 a.m. to 6 p.m. Central Time.
- Pick up a form at a Women, Infants and Children (WIC) Nutrition Program office. Call 1-800-942-3678 (toll-free) to find an office.
2. Along with your filled-out form, we’ll need items that show proof of:
(1) your identity, (2) how much money you get, (3) how much you pay for things like child care and child support, and (4) your citizenship or immigration status.
You can send the proof with your filled-out form but if you need time to gather the items of proof, send us the filled-out application form without the proof.
- Paycheck stub or copy of a check from the last 60 days.
-
Forms that show that someone in your family is in a benefits program:
- Your Texas Benefits Medicaid ID card for one of your children.
- WIC verification of certification (this shows you are in the WIC program).
- WIC voucher.
- WIC / Lone Star Card shopping list.
- A letter from an employer.
- Court papers that show you get child support.
- Unemployment benefit award letter or pay stubs.
- Supplemental Security Income award letter or pay stubs.
- Receipts or income tax returns that show what you pay for day care costs.
- Court papers, canceled checks, wage withholding statements that show how much you pay for child support.
- A U.S. passport.
- A certificate of naturalization.
- A certificate of U.S. citizenship.
The 3 items prove both citizenship and identity. If you don’t have one of these documents, you will need to show 2 documents, one from each list below:
| Proof of citizenship | Proof of identity |
|---|---|
| U.S. birth certificate | Current driver's license with photo |
| U.S. citizen ID card | DPS ID card with photo (for example: Texas ID card) |
| Hospital record of birth | Work or school ID card with photo |
| Northern Mariana ID card | |
| American Indian card with classification code KIC | |
| Religious record of birth with date and place of birth, such as baptism record | |
| Affidavit from 2 adults establishing the date and place of birth in the United States |
An example of an item that shows proof of immigration status is an alien registration card or document from the Bureau for Citizenship and Immigration Services (formerly INS).
You have to prove citizenship, immigration, and identity only one time. You don’t need to send these items again if you reapply.
3. Send us the filled-out application form and items showing proof.
After you fill out and sign the form, you can send it one of these ways:
- Fax the front page of the form and other items we need to 1-866-993-9971. This number is free to call.
- Give the form and copies of other items we need to a clinic that gives these services or to an HHSC benefits office. (To find an HHSC benefits office, go to www.YourTexasBenefits.com and click "Find an office.")
- Mail the form and other items we need to:
Texas Women's Health Program
P.O. Box 14000
Midland, TX 79711-9902
If you pick up a form from a doctor's office, clinic, community organization, or benefits office, a pre-paid envelope might come with it.
Get a Texas Women’s Health Program application here or call us at 1-866-993-9972.
