Forms/Administrative Materials


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Forms


     
  Active Client Record Review Aministration ME Evaluation Tool  
  Active Client Record Review Nutrition ME Tool (Revised Oct. 2010)
  Administration ME Evaluation Tool (Revised Oct. 2011)
  Authorization for Electronic Exchange of Information to the Kansas Immunization Registry consent form-English  
  Authorization for Electronic Exchange of Information to the Kansas Immunization Registry consent form-Spanish  
  Breast Pump Cleaning Instructions  
  Breast Pump Cleaning Instructions - Spanish  
  Breast Pump Helpful Hints  
  Breast Pump Helpful Hints - Spanish  
  Breast Pump Issuance ME Tool (Revised Oct. 2010)
  Breast Pump Questionnaire  
  Breast Pump Questionnaire - Spanish  
  Breast Pump Request for Reimbursements (Revised Oct. 2011)
  Breastfeeding Equipment User Agreement  
  Breastfeeding Equipment User Agreement - Spanish  
  Breastfeeding Peer Counselor Budget Summary (Revised Oct. 2011)
  Breastfeeding Peer Counselor Quarterly Report (Revised Oct. 2011)
  Breastfeeding Peer Counselor Contact Log  
  Check Pick Up Observation ME Tool  
  Child (2-5 Years) Diet Questionnaire  
  Child (2-5 Years) Diet Questionnaire-Spanish  
  Client Interview ME Tool  
  Clinic Observation ME Tool (Revised Oct. 2010)
  Clinic Self-Evaluation ME Tool (Revised Oct. 2010)
  CSFP Fact Sheet (Revised Oct. 2011)
  Declaration of Conflict of Interest  
  Employer Breastfeeding Support Letter (Revised Feb. 2011)
  Financial Support for On-Going Training Application (Revised Dec. 2010)
  Financial Support for IBCLC (New Dec. 2010)
  Fiscal Management ME Evaluation Tool  
  Kansas WIC Client Survey (Revised Oct. 2010)
  Kansas Lost or Stolen Check Replacement Agreement (Revised Oct. 2010)
  Kansas WIC Special Authorization for Infants and Children (Revised Feb. 2010)
  Kansas WIC Special Authorization for Women (New Feb. 2010)
  KWIC Manual Backup Form Child-Infant (Revised Jan. 2011)
  KWIC Manual Backup Form Woman (Revised Jan. 2011)
  Local Agency Warning Notification Letter Sample 1 (Revised Oct. 2011)
  Local Agency Warning Notification Letter Sample 2 (Revised Oct. 2011)
  Minimum Stock Exemption Form (Revised Oct. 2010)
  Minimum Stock Requirements - Rural (Revised Oct. 2010)
  Minimum Stock Requirements - Urban (Revised Oct. 2010)
  Nutrition ME Tool (Revised Oct. 2010)
  Prenatal Diet Questionnaire  
  Prenatal Diet Questionnaire-Spanish  
  Postpartum Diet Questionnaire  
  Postpartum Diet Questionnaire-Spanish  
  Request for Reimbursement Form  
  Rights & Responsibilities Form (Revised Oct. 2011)
  Rights & Responsibilities Form - Spanish (Revised Oct. 2011)
  School Breastfeeding Support Letter (Revised Oct. 2011)
  Secondary Nutrition Education Observation Low and High Risk ME Tool (Revised Oct. 2010)
  Special Formula Authorization ME Tool (Revised Oct. 2010)
  Standard WIC Affidavit (Revised Oct. 2011)
  Suspension Letter for Program Abuse (Revised Oct. 2011)
  Toddler (6-24 months) Diet Questionnaire  
  Toddler (6-24 months) Diet Questionnaire-Spanish  
  Tracking for Receipt and Disposition of Returned Formula ME Tool (Revised Oct. 2010)
  Vendor Application Packet (Revised Oct. 2011)
  New Vendor Evaluation Form (Revised Oct. 2010)
  Vendor Manual (Revised Oct. 2011)
  Vendor Monitoring Form (Revised Oct. 2011)
  Vendor Participation Contract (Revised Oct. 2011)
  Voter Registration - Declination Form  
  Registracion de Votos - Forma de Negasion - Spanish  
  Weight Gain Grids (New Jan. 2011)
  WIC Fact Sheet (Revised Oct. 2011)
  WIC Fact Sheet - Spanish (Revised Oct. 2011)
  WIC Local Agency Budget Summary (Revised Oct. 2011)
  WIC Local Agency Budget FFY2013 (Revised Oct. 2011)
  WIC Product Inventory (Revised Oct. 2011)
  WIC Proxy Form  
  WIC Publications Order Form (Revised Oct. 2011)
  WIC Time Study Forms  
  WIC Civil Rights Discrimination Complaint Form  
  Young Infant Diet Questionnaire  
  Young Infant Diet Questionnaire-Spanish