Kansas WIC Program
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Local Agencies
- Forms/Administrative Materials
Forms/Administrative Materials
Ordering Forms
Forms
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 Questionnaire
Breast Pump Questionnaire - Spanish
Breast Pump Request for Reimbursements
Breastfeeding Equipment User Agreement
October 2012
Breastfeeding Equipment User Agreement - Spanish
October 2012
Breastfeeding Peer Counselor Budget Summary
October 2012
Breastfeeding Peer Counselor Quarterly Report
Breastfeeding Peer Counselor Contact Log
CSFP Fact Sheet
October 2012
Declaration of Conflict of Interest
Diet Questionnaire – Child (2-5 Years)
October 2012
Diet Questionnaire – Child (2-5 Years) - Spanish
Diet Questionnaire – Prenatal
October 2012
Diet Questionnaire – Prenatal – Spanish
Diet Questionnaire - Postpartum
October 2012
Diet Questionnaire – Postpartum – Spanish
Diet Questionnaire – Toddler (6-24 Months)
October 2012
Diet Questionnaire – Toddler (6-24 Months) – Spanish
Diet Questionnaire – Young Infant
Diet Questionnaire – Young Infant - Spanish
Employer Breastfeeding Support Letter
Financial Support for On-Going Training Application
Financial Support for IBCLC
Kansas WIC Client Survey
Kansas Lost or Stolen Check Replacement Agreement
October 2012
KWIC Manual Backup Form Child-Infant
KWIC Manual Backup Form Woman
Local Agency Expenditure Tracking Form
Local Agency Inventory Tracking Form
Local Agency Warning Notification Letter Sample 1
Local Agency Warning Notification Letter Sample 2
Management Evaluation – Active Client Record Review Tool, Administration
Management Evaluation – Active Client Record Review Tool, Nutrition
Management Evaluation – Administrative Evaluation Tool
Management Evaluation – Breast Pump Issuance Tool
Management Evaluation – Check Pick Up Observation Tool
Management Evaluation – Client Interview Tool
Management Evaluation – Clinic Observation Tool
October 2012
Management Evaluation – Clinic Self-Evaluation Tool
Management Evaluation – Fiscal ME Tool
October 2012
Management Evaluation – Nutrition Tool
Management Evaluation – Secondary Nutrition Education Observation Tool
Management Evaluation – Special Formula Authorization Tool
Management Evaluation – Tracking of Returned Formula Tool
Minimum Stock Exemption Form
October 2012
Minimum Stock Requirements - Rural
October 2012
Minimum Stock Requirements - Urban
October 2012
Request for Reimbursement Form
October 2012
Rights & Responsibilities Form
Rights & Responsibilities Form - Spanish
School Breastfeeding Support Letter
Special Authorization – Infants and Children
October 2012
Special Authorization – Women
October 2012
Special Authorization – Pediatric Medical Formulas FAQ
April 2013
Special Authorization – Sample Denial Letter
April 2013
Special Authorization – WIC Formula Fact Sheet
April 2013
Standard WIC Affidavit
February 2013
Suspension Letter for Program Abuse
Vendor Application Packet
October 2012
New Vendor Evaluation Form
Vendor Manual
October 2012
Vendor Monitoring Form
Vendor Participation Contract
October 2012
Voter Registration - Agency Voter Declaration Form
January 2013
Voter Registration - Agency Voter Declaration Form - Spanish
January 2013
Voter Registration - Notice to Applicant
January 2013
Voter Registration - Application
January 2013
Voter Registration - Application - Spanish
January 2013
Weight Gain Grids
WIC Fact Sheet
October 2012
WIC Fact Sheet - Spanish
October 2012
WIC Local Agency Budget FFY2014
WIC Local Agency Budget FFY2013
WIC Product Inventory
October 2012
WIC Proxy Form
October 2012
WIC Publications Order Form
WIC Time Study Forms
WIC Civil Rights Discrimination Complaint Form
Local Agency
Resources:
Policy and Procedure Manual
WIC Staff Change
Nutritional Risk Factors
Diet Questionnaires and Guidance
Nutrition Management Guidelines
Policy and Information Memos
Training
Nutrition Services Plan Guidance
Nutrition Education Materials
Breastfeeding Materials
Forms/Administrative Materials
Nutrition and WIC Update Newsletter
KWIC Focus
WIC Advisory Committee
Nutrition Education Committee
Agency Sharing