How to Enroll

To apply for enrollment in the World Trade Center Health Program (WTCHP) as a "General Responder," you must complete the below downloadable application form and send it to the WTCHP along with the required documentation. Eligibility decisions are made by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention, which administers the WTCHP. Individuals interested in enrollment information for other eligible groups (FDNY, NYC Survivor, and Pentagon/Shanksville, PA Responders), can visit the CDC's website.

Download a General Responder Form:

Eligibility Form - English [PDF]

Eligibility Form - Spanish [PDF]

Eligibility Form - Polish [PDF]

Follow the directions on the form. You can download the form and complete it electronically or you can print it and complete it manually. If you complete the form electronically, you will need to print the form and sign and date it before sending your application. If you have any questions, call the World Trade Center Health Program toll free at 1-888-982-4748 (1-888-WTC-HP4U).

Contact Us

Center Locations

Manhattan Clinical Center
Please note the temporary clinic address during renovations through Spring 2015:
5 East 98th Street, 3rd Floor
New York, NY 10029

Staten Island Clinical Center 
690 Castleton Ave, 2nd Floor
Staten Island, NY 10310
Tel: 888-702-0630

Hudson Valley Clinical Center
1020 Warburton Avenue
Yonkers, NY 10701
Tel: 888-702-0630