Partnership Inquiry Form

Let’s Partner to Make a Difference!

Are you part of a WIC agency, healthcare organization, or community program interested in partnering with wichealth? Whether you're exploring nutrition education solutions or want to collaborate on innovative outreach projects, we’d love to connect with you.

By filling out the form below, you're taking the first step toward a partnership that supports WIC families nationwide.

Note for WIC Participants: If you are a WIC client looking for help with your nutrition education or using wichealth, please return to wichealth.org and tap the "Help" Button for assistance.

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Email *
Name *
In what state do you live? *
Phone Number (optional) – In case we need a quicker chat.
Role/Title – Tell us about your role.
*
Organization Name – The team or organization you represent.
*
What kind of partnership are you interested in? – Let’s talk about how we can collaborate (check all that apply):
How can we help?
*
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