Policies & Forms

LOCAL AGENCIES: Policies & Forms

Use the links below to access many of the resources, policies, and materials your local agency may need.

You can download administrative forms, posters, and handouts right from your computer, and use the Local Agency Resource Guide to order additional incentives and educational materials from approved vendors online.

The WIC Hub

Local Agency Resource Guide

Materials Order Form

Complaint Form (Civil Rights)

Voter Registration Agency Certification Form (En/Sp)

General Administrative Forms:

Affidavit of Guardianship

Alternate Authorized Representative

Complaint Form (RE: WIC Vendor)

Documentation Check Off List

Medical Prescription Form

Notice of Appointment

Notice of Ineligibility

Notice of Program Violation

Notice of Termination (En)

Referral Form

Self Declaration of Relationship by Minor

Signature for Certification (En/Sp)

Suggestion Form

Verification of Employment

Voter Mail-In Registration Form (En/Sp)

IX. Food Delivery

X. Monitoring and Audits

I. Vendor Management

II. Nutrition Services

III. Management Information System

IV. Organization and Management

V. Nutrition Services & Administration (NSA)

VII. Caseload Management

VIII. Certification, Eligibility and Coordination of Services

XI. Civil Rights

XII. Administrative Procedures

Policy and Procedure Manual:

WIC ID Folder / Food List:

WIC ID Folder (English)

WIC ID Folder (Spanish)

WIC Foods & Formulas

Assessment Tools:

Management Evaluation Forms:

Pre-ME Forms

Pre-ME Questionnaire

Recipe Card Template

FMNP Event Flyer Template

WOMEN, INFANTS,

& CHILDREN

DC WIC COVID-19 Response

DISTRICT OF COLUMBIA WIC STATE AGENCY

CALL US: 202-442-9397

Hours of Operation: Monday - Friday, 8am-4:45pm

General Administrative Forms:

Policy and Procedure Manual:

WIC ID Folder / Food List:

Assessment Tools:

Guides

Posters:

FMNP & Market Materials:

Management Evaluation Forms:

Pre-ME Forms

ME Documentation Forms

USDA Nondiscrimination Statement