Outreach Resources & Materials:
Application

If you’d like to order bulk quantities of the CHIP/Children’s Medicaid/CHIP perinatal application, gather the following information:

  • Contact name
  • Contact phone number
  • Street address and suite number (no PO Boxes)
  • City, and zip
  • Name of the application requested (CHIP/Children’s Medicaid application)
  • Number of applications requested

Email that information to this address.