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Michigan WIC Store Complaint

Client Information

Contact information is important for complaint follow-up and resolution. If you would like to remain anonymous, please enter N/A. However, please note that this may make it more difficult to resolve your complaint.

1. The person making the complaint is a: *This question is required.

Please enter an 'other' value for this selection.

2. Email of person filling out this form. *This question is required.

3. Client/Participant Details *This question is required.

Name
Family/Client ID or WIC Card #
Phone Number
Email

4. How would client/participant like to be contacted? *This question is required.

5. Current benefit issuance period (MM/DD - MM/DD) *This question is required.

6. Are you filling this form out on behalf of someone else? *This question is required.

7. Details of person filling out this form if not client/participant.

Name
Phone Number
Email
Local/State Agency Info