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WIC Forms

  • Funding Application Fill-In Forms 
  • Participant Report Concerning Vendors - Mail-In Form (PDF)"Opens a new browser window" 
  • Participant Report Concerning Vendors - Online Form

    • California Department of Public Health (CDPH) Forms

  • CDPH 4143 (PDF)"Opens a new browser window" - Infant Screening and Medical Justification for Therapeutic Formulas
  • CDPH 4144 (PDF)"Opens a new browser window" - Child Screening and Medical Justification for Therapeutic Formulas
  • CDPH 4150 (PDF)"Opens a new browser window" - Therapeutic Formulas Request
  • CDPH 4476 (PDF)"Opens a new browser window" - Dual Participation/Participant Abuse Report
  • PM 247 1 (PDF)"Opens a new browser window" - WIC Referral for Pregnant Woman
  • PM 247 2 (PDF)"Opens a new browser window" - WIC Referral for Postparnum/Breastfeeding Woman
  • PM 247 A (PDF)"Opens a new browser window" - WIC Pediatric Referral
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     Office of State Publishing (OSP) Forms

  • OSP 501 (PDF)"Opens a new browser window" - WIC Nutrition Education, Prenatal/Postpartum, & Breastfeeding Materials
  • OSP 502 (PDF)"Opens a new browser window" - WIC Orientation, Outreach, and Food Package Materials
  • OSP 503 (PDF)"Opens a new browser window" - WIC Infant and Children Materials
  • OSP 504 (PDF)"Opens a new browser window" - WIC Administrative Materials
  • OSP 508 (PDF)"Opens a new browser window" - WIC Vendor Materials
  • OSP 509 (PDF)"Opens a new browser window" - WIC H.E.A.L. Education Materials

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