Tool Kit for Schools or School-Based Programs


The Department of Health’s website on eligibility policy for Medicaid

The Department of Health’s website on eligibility policy for CHIP

Enrollment Process Checklist

Department of Workforce Services

Medicaid/CHIP/UPP/PCN Application:

Medicaid/CHIP/UPP/PCN Application – Online Application

Medicaid/CHIP/UPP/PCN Application – Hard Copy Application

Medicaid/CHIP/PCN/UPP Application - Hard Copy Application (SPANISH)

Authorization Form – Family member signs this form to give you permission to access their information for enrollment process.

Authorization Form (SPANISH)

List of Required Documents for Enrollment

Income Guideline Flyer to use in your School

Examples of Outreach Materials for Schools:

Alpine School District Example

Example Brochure - Jordan School District

Health Services Department Example

Business Card Example

General Resources in Salt Lake County

Safety Net Dental Clinics in Utah

Please give us feedback on the Take Care Utah Tool Kit
Call Randal 801-433-2299 or email

Would you like to be involved in policy work? As you or your school helps families qualify for coverage, you may have concerns with current policy or DWS practices.  From our work with families we learn about what’s working and what’s not in current health policy.  Contact UHPP and learn how to reach your state representative and/or senator to talk about health care in your community. Ask us for an advocacy training or training on the Affordable Care Act.


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