Partner Agency - Report WIC Nutrition Education Classes
Please submit 1 form per class
Partner Information
Partner Agency
Submitter First Name
Submitter Last Name
Submitter Email
Submitter Phone
Class Information
Class Name
Class Completion Date
Class Instructor
File Attachment
Please submit a list of attendees. Include: Name of person who attended the class, WIC Participant Name & Date of Birth, Phone Number and WIC Family ID (if available)
If you experience issues with this form, please call 503-988-3503
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