Online Application

Fill Out Your Application Online — Quick and Easy!

This application is for families whose children are not currently enrolled in the Healthy Kids programs. If your child is currently enrolled and you need the application for your annual renewal, please click here.

There are a few important things you need to know before you start:

• This process allows you to fill in the PDF of the application online. You will need to print this application and mail it to us.
• You cannot save your information. If you have to stop and exit the site, you will have to start over.
• If you have more than four children, you cannot fill out the application online. Please click here to download the application and fill it out by hand.
• There are six pages to complete. Before starting the application, it will be helpful to gather the following documents:

• Birth certificates
• Social security numbers
• Employment and income information
• Current and past health insurance information

• At the end of the 6th page, you will see a button that says “Print & Continue.”  Make sure you click that button to print your application.
• After you print it, sign page 6 and mail all of the pages to us with your documents. We can not process your application until we receive the mailed copy with your documents.
• Mail your completed application to:
  NH Healthy Kids
  1 Pillsbury Street, Suite 300
  Concord, NH 03301-3556

If you have any questions, please call us at 1-877-464-2447 or email .

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