WIC VENDOR PROOF OF TRAINING

DEPARTMENT OF HEALTH SERVICES Division of Public Health F-44727 (rev. 09/2021)	STATE OF WISCONSIN Title 7 CFR Part 246.12(i) Wis. Admin. Code DHS 149.08 (608) 266-6912
WIC VENDOR PROOF OF TRAINING WISCONSIN WIC PROGRAM
WIC vendor training is designed to prevent program errors and noncompliance, and to improve program service. Vendors must designate at least one representative to complete vendor training when required by the state WIC office. Failure to complete required training may result in denial of the WIC application or termination of the WIC authorization. Vendors are responsible for ensuring all personnel who process WIC transactions are trained in eWIC redemption and processing procedures.

Type your store name or the beginning numbers of your store street address below. A dropdown list with store options will display. Select your store from the list. The remaining fields will auto-fill with the store information WIC has on file. Verify this information is correct. If you chose the wrong store, click on the “reset form” button to clear all fields and start over. The auto-fill fields cannot be changed. Contact the WIC Vendor Unit at 608-266-6912 if the information displayed for your store is incorrect or if you have questions about completing this form.

Store – Name

Store Name is required

Store – Street Address

Street Address is required

For WIC Office Use:
WIC Vendor Number

Store – Phone Number (include area code)

Phone Number's Area code is required
Phone Number is required

Interactive Training Type (mark one):

Interactive Training Content (mark all that apply):

The WIC vendor interactive training covered the following topics(mark all that apply):

Purpose of the WIC Program	Vendor claims
eWIC transaction and redemption procedures	Authorized WIC infant formula suppliers
WIC approved foods	Violations of the WIC Program and sanctions for offenses
Minimum stock requirements	Complaint procedure
Use of incentive items	Changes to the WIC program since the last WIC training

Type the full name of the person who completed the training, their job title and the actual training date. Once you have finished completing the form, click on the “submit” button below. The message “Proof of Training added successfully” will display at the bottom of the page, confirming the information was saved. Scroll to the bottom of the page and click the “print” button to print a copy for your records. You will not be able to view or print your completed form after you leave this page.
Person who completed training - Name (type or print full name) Person - Name is required	Job Title/Position Job Title/Position is required	Date – WIC Training Training Date is required