I Want To Apply

1. Download the Apple Health for Kids pdf application form:

   English

   Cambodian

   Chinese

   Korean

   Laotian

   Russian

   Spanish

   Vietnamese

2. Complete the form, sign it and mail it to us at the address listed on the form.

Reminders

• Your child does not have to be a citizen to receive health coverage in Washington State. If your child is a citizen, we will need to verify his or her citizenship. We will mail you a special form for that information after we receive your application.

• Enter the amount of your income before taxes.

• Be sure to include a phone number where we can reach you.

• Be sure to include all the children living with you. That can make a difference in whether you have to pay monthly premiums or not.

If you need help with this form or have questions

• Contact someone directly in your county.

• Tribal Contacts for Native American applicants.
  
  

• Call the DSHS Community Service Office closest to you. You can find the office’s phone number and address by using this helpful locator device.

• Call the Medical Assistance Customer Service Center toll-free at 1-800-562-3022 between 7 a.m. and 5:30 p.m. weekdays.