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WIC Documentation Submission
Interpreter needed? ¿Se necesita intérprete?
YES
NO
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email - correo electronico
example@example.com
Phone Number - confirme numero de telefono
*
-
Area Code
Phone Number
Confirm Phone Number
*
-
Area Code
Phone Number
How many people in your household? - cuantas personas en su hogar
*
Count unborn baby as part of your household. Example: Pregnant mom counts as 2. - 2-cuente el bebe como parte de su hogar. Ejemplo: mama embarazada cuenta como dos.
Proof of ID - prueba de identificacion
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Accepted File types are jpg, jpeg, gif and png. Select multiple files by holding CTRL Key.
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Proof of Address - comprobante de domicilio
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Accepted File types are jpg, jpeg, gif and png. Select multiple files by holding CTRL Key.
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of
Proof of Income for your entire household. - comprobante de ingresos de todo su hogar.
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Accepted File types are jpg, jpeg, gif and png. Select multiple files by holding CTRL Key.
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of
Immunization Records for any children under the age of two. - cartilla de vacunacion de cualquier nino menor de dos anos.
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Accepted File types are jpg, jpeg, gif and png. Select multiple files by holding CTRL Key.
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Additional Documents. - documentos adicionales
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Accepted File types are jpg, jpeg, gif and png. Select multiple files by holding CTRL Key.
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Is there anything you need us to know about these documents? - hay algo que necesite que sepamos sobre estos documentos?
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