Applications & Forms

Complete Applications Using the Benefit Finder:

A quick and easy way to apply for programs is to use the Benefit Finder. It saves you time by helping you learn which programs you may qualify for, and helps you fill out applications on-line.

However, if you would like to print a blank copy of the applications and fill them out by hand, click on the applications below.

Print DSHS Applications:

• Children’s Health Insurance (Medicaid & SCHIP) – called Apple Health for Kids
  • Information Sheet – a summary of the free and low cost children’s health insurance programs and simple directions on how to apply
  • Apple Health for Kids Flyer (English and Spanish)

• Renewal Form for Children’s Health Insurance – DSHS will send you a letter when this yearly benefits review is due. You can fill in this form online, print and mail it to the address in the letter.

• First Steps (Pregnancy Medicaid)
  • Information Sheet – program summary and how to apply
  • Completed applications should be sent to your local DSHS office.

• Application for Benefits – use for Food Stamps, Family Medical, TANF, GAU
  • Information Sheet – simple directions on how to apply for benefits
  • Helpful Hints on using your Food Stamp EBT Card
  • Completed Applications for Benefits should be sent to your DSHS office.

To request an application be mailed to you, or for more information about the programs, call the Family Health Hotline at 1-800-322-2588.

Additional DSHS Forms You May Need:

• Income 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 – If you stopped work due to a lay-off, temporary status, leave, etc. have your recent employer fill out this form

• Other Forms
  • Statement of Shared Living Arrangement – explains how the people who live at your address share expenses. This form is used in applying for food stamp benefits.
  • Statement from Landlord / Manager – provides proof of your housing costs
  • Change of Circumstance Form – report changes of address, income, expenses, family size, etc.
  • DSHS Client Rights and Responsibilities – what you need to know about applying for and receiving benefits from DSHS
  • DSHS Family and Children’s Medical Benefits Renewal – if your child is already enrolled in Children’s Health Insurance and needs to renew coverage, use this form

WIC Nutrition Program:

There is no application for WIC.

• Use the WIC Search Tool to find your local WIC office.