WIC is a federally-funded health and nutrition program for women, infants, and children. WIC provides nutrition education, breastfeeding support and supplemental food all for free!
WIC strengthens families!
Forms for WIC Enrollment
These forms are needed to complete enrollment in the WIC Program. You may fill them out and submit to your Local Agency ahead of your appointment, or expect to complete them on site before your appointment:
Need a prescription or referral form to take to your provider?
for prescription of special formulas or medical foods
to document height, weight, blood iron levels, and other information relevant to WIC participation
Voter Registration Forms
The following mail-in voter registration applications are fillable forms which can be printed and mailed to the address found on the form:
To register to vote online, please visit:
Print the form you need and bring it to your provider. If you need a special formula, your provider must include:
patient's name and information
recent medical data
type of formula or adjustments to the food package
prescription length of time
qualifying medical condition
provider signature and information
If any information is missing, you may be told that the form is incomplete.
Need a friend or family member to help you with your appointments?
Fill out the Alternate Authorized Representative form and bring to your next appointment. This form allows someone else to participate in the WIC certification process and/or pick up WIC checks with your permission.