Get the free WIC Referral Form - Wake County Government
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WIC REFERRAL FORM To Schedule a WIC Appointment call: (919) 250-4720 CLIENT NAME BIRTHDATE Please check the category that applies to your client: Infant (younger than 11 months) Child (11 months to
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What is wic referral form?
The WIC referral form is a document used to refer individuals to the Women, Infants, and Children (WIC) program, which provides nutrition assistance to low-income pregnant women, new mothers, and young children.
Who is required to file wic referral form?
Healthcare professionals, social workers, and other authorized individuals are required to file the WIC referral form to refer eligible individuals to the WIC program.
How to fill out wic referral form?
To fill out the WIC referral form, you need to provide the applicant's personal information, including name, contact details, and demographic information. Additionally, you need to document their income, nutritional needs, and any supporting documentation for eligibility.
What is the purpose of wic referral form?
The purpose of the WIC referral form is to identify individuals who may qualify for the WIC program and refer them for enrollment. This form helps ensure that eligible individuals receive the necessary nutrition assistance.
What information must be reported on wic referral form?
The WIC referral form requires reporting of personal information such as the applicant's name, address, contact details, and demographic information. Additionally, income details, nutritional needs, and any supporting documentation for eligibility must be included.
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