WIC in Vermont

The Proof of Delivery Form

POD Form


How to Complete the POD

1 District health office and telephone number
2 Your vendor's name, address and telephone number
3 Head of household and address
4 The names of WIC participants in your household
5 The month you need to recertify your WIC
6 The food to be delivered
7 The total amount of food you will receive each month
8 The weeks that your food will be delivered
9 Write in any missing food items
10 Sign the form at the end of each month

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