Applications & Forms
A quick and easy way to apply for food and health insurance is to use the Benefit Finder. It saves you time!
Below you will find supplemental forms that you may be asked to fill out and return when applying for certain benefit programs.
Additional DSHS Forms You May NeedIncome Verification
- Self-employment worksheet – Use this income form if you are self-employed
- Employment Verification – Employers can verify your income using this form
- Stop Work Form – Lay-off, temporary leave, etc. have your recent employer fill out this form
- Statement from Landlord / Manager – Provides proof of your housing costs
- Change of Circumstance Form – Report address, income, expenses, family size change
- DSHS Client Rights and Responsibilities – What you need to know about applying for and receiving benefits from DSHS
Washington Apple Health for Pregnant Teens
There is a new insurance program for pregnant teens. To be eligible, a pregnant teen must be a Washington State resident under age 19. There is no income limit for the program. Pregnant teens in this program will be treated as an independent household and will not need to provide their parent’s income or financial information. Do not apply for pregnant teen coverage on Washington Healthplanfinder. Instead, call our Apple Health Hotline toll-free at 1-877-543-7669.
To apply, complete the paper application below.
Application for Pregnant Teen Health Care Coverage
Mail your completed application to:
Medical Eligibility Determination Services
PO Box 45531
Olympia, WA 98504-5531
WIC Nutrition Program
There is no application for WIC.