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WIC Application
WIC Application
York County Community Action Corporation
6 Spruce Street, Sanford, ME 04073
Phone (1 800 965-5762) FAX (207 490-6695)
You may qualify if (Please check one)
____ You have a child younger than 5 years old, or
____ You are pregnant
Parents First Name _______________________ Last Name _____________________
Childs Name _____________________________ Birthdate _____________________
Childs Name _____________________________ Birthdate _____________________
Childs Name _____________________________ Birthdate _____________________
Childs Name _____________________________ Birthdate _____________________
Home Address __________________________________________________________
City __________________________ State __________________ Zip ____________
Telephone ______________________________Email___________________________