Page 1

WIC services last fiscal year 8 Number of local agencies planned to provide WIC services this fiscal year 8 0 When does the State agency accept applications from potential local agencies? <☐> Annually <☐> Biennially <☐> On an on-going basis <☐> Other (specify) On an as needed basis 1 Does the State agency require existing local agencies to reapply and compete with new applicant agencies for authorization? <☐> Yes <☐> No If yes, what is the frequency? <☐> Annually <☐> Biennially 0 ☒Not applicable ☐Ot敨⁲猨数楣祦 汃捩牯琠灡栠牥⁥潴攠瑮牥琠硥⹴഍匍汥捥 楴湯䌠楲整楲ൡ桔⁥瑓瑡⁥条湥祣甠敳⁳桴⁥潦汬睯湩牣瑩牥慩椠敳敬瑣湩潬慣条湥楣獥椠敮⁷ 敳癲捩⁥牡慥⁳湡⽤牯椠敲楶睥湩灡汰捩瑡潩獮映潲硥獩楴杮猠牥楶散愠敲獡›䌨敨正愠汬 琠慨⁴灡汰⥹不 睥匠牥楶 散䄠敲獡 䔇楸瑳湩 敓癲捩⁥牁 慥 ݳ܇< 111111 111111111 111111111 11122222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2 ☐ > <☐> Coordination with other health care providers <☐> ☒ Projected cost of operations/ability to operate with available funds <☐> ☒ Location/participant accessibility <☐> ☒ Financial integrity/solvency <☐> <☐> Relative need in the area <☐> ☒ Range and quality of services <☐> ☒ History of performance in other programs <☐> ☒ Ay to serve projected caseload