Health and Community Services
WIC
KALAMAZOO COUNTY WIC APPLICATION FORMS
If you want to apply for WIC for yourself and/or your children, please select the appropriate forms listed below to print and complete before you come to the WIC office. Having the forms completed before you visit us will save you some time.
(In order to download these documents, Adobe Acrobat Reader is required. If you do not have this software, you can download it for FREE using this link.)
If you are Pregnant, fill out the:
 Pregnant Woman's Health History - (en Español)
Family History Health Form - (en Español)
If you are Postpartum, fill out the:
Postpartum Woman's Health History (Initial Certification) - (en Español)
Family History Health Form - (en Español)
If you are PostPartum or have had a Miscarriage, fill out the:
PostPartum/Miscarriage Woman's Health History (Initial Certification) - (en Español)
Family History Health Form - (en Español)
If you are applying for your Infant (birth to 1 year of age), and a New participant, fill out the:
Infant Health History - (en Español)
Family History Health Form - (en Español)
For Infant Mid-Certification (baby is at least 6 months of age), fill out the:
Infant Mid-Certification Nutrition/Health Evaluation - (en Español)
Family History Health Form - (en Español)
For each Child that you are applying for (1 through 4 years of age), fill out the:
Child Health History - (en Español)
Family History Health Form - (en Español)
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age, or disability.
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Indepenedence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.
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Health and Community Services programs are open to all without regard
to race, color, national origin, sex or disability.
Links to external sites do not constitute endorsements by Kalamazoo County.
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