How To Apply

To apply, print the Healthcare application from our website, then fill it out, sign it, and mail it in to the Kid Care CHIP office. You cannot fill out the application on the computer, because it must be signed.

How to Print the Application
The Application is available as a PDF file (portable document format). You need software called Adobe Acrobat Reader to print it. You can get Adobe Reader for your Computer HERE.

After you have installed Adobe Acrobat:
• Click HERE to download the ENGLISH APPLICATION. 
  (Click here if you prefer a black and white version)

• Click HERE to download the SPANISH APPLICATION. 
  (Click here if you prefer a black and white version)

Before you turn in the application, please read through all instructions and information included in the application.

If you cannot print the application for any reason, you can get one
from one of the many application sites throughout the state or call
KidCare CHIP at 1-877-543-7669.
CLICK ON ANY COUNTY TO VIEW SITE INFORMTION: