Submit Eligibility and After Visit Summary Documents
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Submitter Information
Relationship to WIC Participant
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Parent or Guardian
Foster Parent
Case Worker
Self
Submitter First Name
Submitter Last Name
Submitter Phone
WIC Participant Information
First Name
Last Name
Date of Birth
Please enter DOB in this format mm/dd/yyyy
WIC Family ID (8 digits)
Phone
Preferred Language
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English
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Vietnamese
Cantonese
Somali
Karen
Arabic
Dari
Burmese
Ukrainian
Rohingya
Nepali
Swahili
Maay Maay/Mai Mai
Tigrinya
Other
Eligibility and After Visit Summary Documents
File Description
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Proof of Income
Proof of Address
Proof of ID (for WIC participant)
After Visit Summary
What type of document are you uploading?
Eligibility Document
Please only upload .PDF, .DOC, .JPG, or .PNG files
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