Wood County, Wisconsin

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Application for the Wood County WIC Program

Participation in the WIC program is voluntary. Completion of this form is required to determine WIC eligibility and any personally identifiable information collected will be used for that purpose only.

Answer the following questions to the best of your knowledge. All information will be kept confidential.

Name, sex, and birth date for each of your children under age 5

Child 1
Child 2
Child 3
Child 4
Child 5

Submit Application