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Forms / Administrative Materials
- Abbreviations From Local Agencies (PDF)
- Acknowledgment of receipt of Direct Ship Formula from Kansas Nutrition and WIC Services (PDF)
- Affidavit of Expenditures (XLSX)
- Application for Kansas Local Agency NWA Committee Representative (DOCX)
- Authorization for Electronic Exchange of Information to the Kansas Immunization Registry consent form-English (PDF)
- Authorization for Electronic Exchange of Information to the Kansas Immunization Registry consent form-Spanish (PDF)
- Authorization to Share Kansas WIC Information - PDF - English (PDF)
- Authorization to Share Kansas WIC Information - PDF - Spanish (PDF)
- Authorization to Share Kansas WIC Information - Word - English (DOCX)
- Authorization to Share Kansas WIC Information - Word - Spanish (DOCX)
- Breast Pump Questionnaire - Spanish (PDF)
- Breast Pump Questionnaire (PDF)
- Breast Pump Request for Reimbursements (PDF)
- Breastfeeding Equipment User Agreement - Spanish (PDF)
- Breastfeeding Equipment User Agreement (PDF)
- Breastfeeding Peer Counselor Program Annual Evaluation (PDF)
- Breastfeeding Peer Counselor Program Application Packet (PDF)
- Breastfeeding Peer Counselor Quarterly Report (XLSX)
- Breastfeeding Peer Counselor Quarterly Report Guidance (PDF)
- Breastfeeding Peer Counselor Review Report Form (DOCX)
- Breastfeeding Peer Counselor Staff Evaluation (PDF)
- Budget Template and Checklist FFY2023 (XLSX)
- Budget Template and Checklist FFY2024 (XLSX)
- Card Inventory Control Form (PDF)
- Coffective Sample Letter for Kansas Physicians (DOCX)
- Contract Military Commissaries Memorandum of Understanding (PDF)
- Declaration of Conflict of Interest (PDF)
- Direct Ship Order Form for Local Agencies (XLSX)
- e WIC Manual Backup Form Child, Infant (PDF)
- e WIC Manual Backup Form Woman (PDF)
- Employer Breastfeeding Support Letter (PDF)
- Financial Support for IBCLC (PDF)
- Financial Support for On-Going Training Application (PDF)
- Formula Tracking Sheet for Returns and Dispositions-Enterable Form (DOCX)
- Formula Tracking Sheet for Returns and Dispositions-Word (DOCX)
- Kansas WIC Client Survey - Spanish (PDF)
- Kansas WIC Client Survey (PDF)
- KWIC Manual Backup Form Child-Infant (PDF)
- KWIC Manual Backup Form Woman (PDF)
- Local Agency Active Chart Review (PDF)
- Local Agency Clinic Site Observation (PDF)
- Local Agency Expenditure Tracking Form (XLSX)
- Local Agency Inventory Worksheet (PDF)
- Local Agency Warning Notification Fillable Form (PDF)
- Management Evaluation - Active Client Record Review Tool, Administration (PDF)
- Management Evaluation - Active Client Record Review Tool, Nutrition (PDF)
- Management Evaluation - Administrative Evaluation Tool (PDF)
- Management Evaluation - BFPC Program (PDF)
- Management Evaluation - Breast Pump Issuance Tool (PDF)
- Management Evaluation - Client Interview Tool (PDF)
- Management Evaluation - Clinic Observation Tool (PDF)
- Management Evaluation - Clinic Self-Evaluation Tool (PDF)
- Management Evaluation - Fiscal ME Tool (PDF)
- Management Evaluation - Nutrition Tool (PDF)
- Management Evaluation - Secondary Nutrition Education Observation Tool (PDF)
- Management Evaluation - Special Formula Authorization Tool (PDF)
- Management Evaluation - Tracking of Returned Formula Tool (DOCX)
- Measurements Required Email (DOCX)
- Measurements Required Email Spanish (DOCX)
- Measurements Required Flyer (PDF)
- Measurements Required Flyer Spanish (PDF)
- Military Commissary MOU Kansas WIC (PDF)
- Minimum Stock Exemption Form (PDF)
- Minimum Stock Requirements - Rural (PDF)
- Minimum Stock Requirements - Urban (PDF)
- New Vendor Evaluation Form (PDF)
- Request to Add a UPC Form (PDF)
- Rights and Responsibilities Form - Spanish (PDF)
- Rights and Responsibilities Form (PDF)
- School Breastfeeding Support Letter (PDF)
- Seperation of Duties Exception Log (PDF)
- Special Authorization - Infants and Children (PDF)
- Special Authorization - Pediatric Medical Formulas FAQ (PDF)
- Special Authorization - Sample Denial Letter (PDF)
- Special Authorization - WIC Formula Fact Sheet (PDF)
- Special Authorization - Women (PDF)
- Vendor Application Packet (PDF)
- Vendor Manual (PDF)
- Vendor Monitoring Form (PDF)
- Vendor Participation Contract (PDF)
- Voter Registration - Agency Voter Declaration Form - Spanish (PDF)
- Voter Registration - Agency Voter Declaration Form (PDF)
- Weight Gain Grids (PDF)
- WIC Civil Rights Discrimination Complaint Form - Spanish (PDF)
- WIC Civil Rights Discrimination Complaint Form (PDF)
- WIC Fact Sheet - Spanish (PDF)
- WIC Fact Sheet (PDF)
- WIC Product Inventory (PDF)
- WIC Publications Order Form (PDF)
- WIC Time Study Forms (XLS)