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


Stay tuned! Vermont WIC will be transitioning from home deliveries of WIC foods to an electronic benefits transfer based system using the new Vermont WIC card. When your district office location makes the change to eWIC, you will no longer need anProof of Delivery Form.

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