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Incomplete
New WIC CVC Applicant
Preference: Email
Yes Handicapped
Friday - Participate
Saturday-Participate
FMNP & SFMNP Approved
WIC CVC Approved
Denied
Produce Plus / Rx Approved
I.N.Will Update Upon Signing
Reauthorization
New FMNP Applicant
Preference: Phone
Preference: Text
Partnership
Sole Proprietor
Not for Profit
Cooperative
Yes- Participate in other states
No - do not participate in other states
Yes- Participate in MD FM
No Do not participate in MD FM
No Handicapped
Yes- need vendor stamp
No vendor stamp needed
Yes- Participate
No participate
Sunday-participate
Monday Participate
Tuesday participate
Wednesday- Participate
Thrusday-Participate
Tabletop Wireless
PayPal
Square
Other app
Cards not accepted
Yes - EBT processor
No - EBT processor
Paper Checks
EBT Card
Wifi
Mobile Data
Mobile Hotspot
Other - internet
Sunday (1)
Friday (1)
Tuesday (2)
Wednesday (5)
Thursday (5)
No - will not change
Monday (1)
Tuesday (1)
Wednesday (1)
Thursday (1)
Saturday (1)
Sunday (2)
Monday (2)
Wednesday (2)
Thursday (2)
Friday (2)
Saturday (2)
Sunday (3)
Monday (3)
Tuesday (3)
Wednesday (3)
Thursday (3)
Friday (3)
Saturday (3)
Sunday (4)
Monday (4)
Tuesday (4)
Wednesday (4)
Thursday (4)
Friday (4)
Saturday (4)
Sunday (5)
Monday (5)
Tuesday (5)
Friday (5)
Saturday (5)
Yes- will change
Less than 50%
Greater than 50%
Signature HereClick to Sign
Signature HereCounty Extension Agent Will Sign Here
Group10
Yes- I will buy produce
No- I will not purchase produce
Group12
Group11
Group13
x

Additional Signatures Required