Wood County, Wisconsin

Official Website

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

*Please note: WIC provides nutritious foods to cover a portion of an average child’s food intake in a month (not all). Families will still expect to buy food/formula out of pocket each month.

This institution is an equal opportunity provider.
WIC: Non Discrimination Statement: English, En Español, and Hmong

Submit Application