Marion County WIC Program Referral - Marion County WIC Program

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

First Name: Self, parent, or guardian's first name

Last Name: Self, parent, or guardian's last name

Preferred Contact Method:

Language: What language is used in the household?

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.