WIC Referral
Marion County WIC Referral
I am making a referral to the Marion County WIC Program:
For myself, my child, or for a child in my custody
As a community partner or provider referring on behalf of a community member
Please select a referral type
First Name:
Self, parent, or guardian's first name
First name is required
Last Name:
Self, parent, or guardian's last name
Last name is required
Preferred Contact Method:
-- Select --
Email
Text
Phone call
Please select a preferred contact method
Language:
What language is used in the household?
Language is required
Comments:
Maximum 500 characters
I certify that the above is true and understand that false information may nullify the referral. I agree that this application remains the property of Marion County WIC Program.