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WIC- Other Forms To Print

Other Forms You Can Download:
Can't find the form you need? Click here for other form categories!

(45 KB)

Retraining Form (4/10)
This form may be used by vendors to notify us of a problem experienced with a client who does not seem to understand the WIC program rules or how to purchase the correct foods. It can also be used by a client to help us identify cashiers that may need additional training on WIC policies and procedures.

(8 KB)
Alaska WIC Vendor Program Complaint Form:
If you need to register a complaint about the service you received or the supply of WIC products at a WIC store, please complete this form and mail it to the WIC Vendor Coordinator at the address on the bottom of this web page.

(20 KB)\

Enteral Nutrition Prescription Request Form:
Requires the original signature of medical provider licensed to write prescriptions in Alaska and provides the Alaska WIC program with the medical documentation needed to issue WIC warrants to purchase WIC approved non-contract formula.

Application Forms for WIC Participants 
This link takes you to the forms you can print out to apply for WIC.



To address technical problems or make suggestions regarding this site, please email:

Other contact information:
Family Nutrition Services State of Alaska/DHSS/DPA

130 Seward St
PO Box 110612
Juneau, AK 99801

Main office:

(907) 465-3100
(907) 465-3416