WIC Program Forms and Materials

 

Ordering WIC Materials

Orders will be filled and shipped directly to you from the Washington State Department of Printing Fulfillment Center.

Use the instructions below to order from the Washington State Department of Printing's myFulfillment. Internet orders are shipped approximately 2-3 days after the order is placed.

Ordering Instructions

  1. Go to the Department of Printing's website at myfulfillment.wa.gov.
  2. You will be asked if you are new or if you have been here before. Click on the appropriate box.
    • If you are new, you will be asked to enter a user name and password. (Use your email address as your login. This allows Department of Printing to easily find your password should you ever forget it.) If someone else is not using your login, it will immediately be accepted. Write down your login and password for future reference.
  3. Steps to find the products:
    • On the left side select “Fulfillment (By Agency).”
    • Select “Health (DOH).”
    • Select “WIC.”
      • You are now at the WIC materials, which are broken down into categories. Click on the category and then find the item you are wanting.
    • Once you find the item you are looking for, click on the item, input the quantity you wish to order, then click "Add to Cart."
    • Once you click on “Add to Cart” it will place your items in your shopping cart.
  4. You can continue shopping and updating the cart until you have all of the items you wish to receive and then you will need to “Check Out.”
  5. Enter all your shipping information. (Please note—all items will be shipped to a physical address—no PO Boxes please)
    When entering your contact and ship to information please note…
    • Enter your first name in the “First Name” field.
    • Your last name in the “Last Name” field.
    • Enter "WIC Clinic" in the "Organization" field.
    • Please be sure to include your phone number with area code.
  6. Click the “Continue” button and you should see a confirmation of your order.
  7. Please print the confirmation page including the web order number for your records.
  8. If there are any problems with your order or the ordering process please contact us at WIC@doh.wa.gov or 1-800-841-1410. We will need your confirmation order number to track and assist you with your order.

Assessment Questions

Washington WIC uses standardized questions when program eligibility is determined at initial and subsequent certifications. The questions are specific to participant category and infant age. These questions support WIC staff in completing the nutrition assessment, determining WIC risk eligibility and starting a dialogue with the participant about what she or he wants and needs related to nutrition and health.

Assessment Questions in multiple languages

Breastfeeding and Baby Behavior Materials

CDC-WHO Growth Charts

WIC uses the following growth charts for infants and children from birth to 24 months of age. These are the Center for Disease Control (CDC) growth charts based on the World Health Organization (WHO) growth standards.

Grace Period for Proof of Income Form

WIC policy requires that clients fill out and sign the Grace Period for Proof of Income Form (PDF) when proof of income exists but the person didn't bring it to the clinic. See Volume 1, Chapter 6–Income (PDF) for more information.

Hematology Supply Order Forms

  • Use this Hematology Order Form to order all McKesson, Masimo, and HemoCue Hematology supplies.
  • Once we process your order, we will send an acknowledgement email with a copy of your order from WICHematology@doh.wa.gov to keep for your records.
  • Keep the acknowledgement email and the completed order records (packing slip) on file for six years according to fiscal retention policy.
  • Contact WICHematology@doh.wa.gov for questions.

Income Intake Tool

This optional Income Intake Tool (PDF) helps staff gather income information in a more confidential manner. The client can fill out the form and staff ask follow-up questions about the information as needed before entering it in Client Services.

Nutrition Education Materials

0-6 Months–Tips for My First Six Months
6-12 Months-Tips for Me As An Older Baby
Beans: The Bold and Beautiful Book of Bean Recipes
Healthy Fish Guide - Fish/Seafood Wallet Card
Healthy Choices for Kids
Healthy Tips for New Moms
Healthy Weight Gain During Pregnancy
I Can Eat Finger Foods
I'm Ready for a Cup
I'm Ready! Feeding Family Foods to Your Baby
I'm 1 – Let's have fun!
I'm 2 – Look what I can do!
I'm 3 – Please play with me!
I'm 4 – Let's explore!
Iodine information sheet
My Pregnancy, My Baby, and Me: Gestational Diabetes
Pump Up the Iron
Stay Healthy
The Facts About Constipation
Tips for a Healthy Pregnancy
Tips for Feeding Picky Eaters
55 Ways to Add More Fruits and Vegetables Every Day

Overdue Pump Letter

Prenatal Weight Gain Grids

The Washington WIC Nutrition Program uses prenatal weight gain grids based on the 2009 Institute of Medicine (IOM) prenatal weight gain guidelines. A pregnant woman's weight is plotted on a prenatal weight gain grid based on her pre-pregnant Body Mass Index (BMI) and if it is a singleton or multiples pregnancy.

Singleton Grids

Multiples Grids

Printer Cartridge Ordering

This is for State WIC-provided printers.

Race and Ethnicity Tool

Staff provide the Race and Ethnicity Tool (PDF) to participants so they can review the definitions of the federal race and ethnicity categories and provide their self-declared information.

See Volume 1, Chapter 18 – Certification (PDF) for more information.

Rights and Responsibilities Forms

The Rights and Responsibilities form (PDF) was revised to use with Cascades, WIC Cards, and reflect the Participant Violations and Sanctions Table published in the Washington Administrative Code (WAC).

Rights and Responsibilities form - view all languages

Time Study Workbook

This tool helps WIC staff track time worked in the four WIC cost types.

We Missed You Letters

WIC policy states staff send the We Missed You letter for all categories to clients who miss WIC appointments. A separate letter is required for pregnant women who miss their first scheduled WIC appointment. English and Spanish letters will print from CIMS Client Services. All languages are located here for printing.

Letter for pregnant women who miss their first WIC appointment

Letter for all clients who miss WIC appointments

WIC Benefits and Foods

WIC Fair Hearing Brochure

WIC policy requires staff to provide the WIC Fair Hearing brochure (PDF) to applicants and participants who feel staff incorrectly or unfairly determined them ineligible for WIC services. See the Washington State WIC Policy and Procedure Manual Chapter 20 (PDF) for more information.

WIC Fair Hearing brochure - view all languages

WIC Not Eligible (Termination) Letter

WIC policy requires staff to provide the Not Eligible (Termination) letter (PDF) to applicants who don't qualify for WIC services and to clients that staff take off WIC. See the Washington State WIC Policy and Procedure Manual Chapter 20 (PDF) for more information.

WIC Statement of Income Form

Clients sign the WIC Statement of Income Form (PDF) when proof of income doesn't exist, for example when the person has no income, works for cash or income documentation was destroyed in a house fire or natural disaster. See Volume 1, Chapter 6–Income (PDF) for more information.

Healthy Sleep: For you and your baby
I am a Breastfeeding Baby – Crib Card
Understanding Your Baby's Cues
Why Do Babies Cry?
Breast Pump Release of Liability Form