Complaint Against WIC Participant Anonymity I would like to be anonymous Witness Contact InformationYour name and at least ONE contact method is needed for the State Office to be able to follow up on this complaint. If 'anonymous' is selected, we will not share your name with the Clinic.Name* First Last Home PhoneCell PhoneEmail Complaint TypeYou may check up to four (4) complaint types. Attempting to purchase foods not approved by WIC Threatening or verbally abusive towards cashiers or WIC staff Physically abusive towards cashiers or WIC staff Causing clinic/store disruption Inappropriate use of food instruments (no signature, using early) Misrepresentation of eligibility information (income, family size) Dual Participation Sale of WIC items obtained through WIC(formula, breast pumps) Exchanging food instrument(s) for credit or non-food items Altering food instruments Using food instruments at an unauthorized store Stealing WIC food instruments Stealing WIC foods Trafficking of items obtain through WIC (formula, food instruments) Record Request Complaint InformationDate of Incident* MM slash DD slash YYYY Time of Incident : AM PM AM/PM Which clinic?Select WIC ClinicUnknownCarson City Health and Human Services - Gardnerville Clinic #427 - 1524 US 395, Suite 8, Gardnerville, NV, 89410Carson City Health and Human Services - Carson City Clinic #455 - 900 East Long Street, Carson City, NV 89706Catholic Charities - Owens Clinic #801 - 1511 Las Vegas Blvd N., Las Vegas, NV, 89101Catholic Charities - Henderson Clinic #802 - 270 E. Horizon Suite 109, Henderson, NV, 89015Community Health Alliance - Neighborhood Health Clinic #312 - 3915 Neil Road, Reno, NV, 89502Community Health Alliance - Sun Valley Clinic #313 - 5295 Sun Valley Blvd Suite #8, Sun Valley, NV, 89433Community Health Alliance - Sparks Clinic #314 - 2244 Oddie Blvd., Sparks, NV, 89431Community Health Alliance - Head Start Clinic #315 - 1100 East 8th Street, Reno, NV, 89512Community Health Alliance - Vassar Clinic #316 - 2405 Vassar St, Reno, NV, 89502Community Health Alliance - WIC on Wheels Clinic #317 - Mobile ClinicCommunity Health Alliance - Burns Clinic #318 - 1055 South Wells Avenue, Reno, NV, 89502Consolidated Agencies of Human Services - Hawthorne Clinic #409 - 924 5th Street, Hawthorne, NV, 89415Family Resource Centers of Northeastern NV - Elko Clinic #417 - 331 7th Street, Elko, NV, 89801Little People's Head Start - Alamo Clinic #413 - 121 Joshua Tree Street, Alamo, NV 89001Little People's Head Start - Caliente Clinic #414 - 100 Depot Ave., Caliente, NV, 89008Little People's Head Start - Ely Clinic #426 - 435 S. 13th Street, Ely, NV, 89301Lyon County WIC - Yerington Clinic #419 - 26 Nevin Way, Yerington, NV, 89447Lyon County WIC - Dayton Clinic #420 - 5 Pine Cone Road #103, Dayton, NV, 89403Lyon County WIC - Fernley Clinic #424 - 460 West Main Street, #110, Fernley, NV, 89408Lyon County WIC - Silver Springs Clinic #428 - 620 Lake Ave., Silver Springs, NV, 89429Nevada Health Centers - MLK Clinic #204 - 1700 Wheeler Peak Drive, Las Vegas, NV, 89106Nevada Health Centers - Tropicana Clinic #205 - 5486 Boulder Hwy., Suite 102, Las Vegas, NV, 89122Nevada Health Centers - Decatur Clinic #206 - 5085 W. Sahara Ave., Suite #134, Las Vegas, NV, 89146Nevada Health Centers - Gowan Clinic #208 - 3650 N. Rancho Dr., Suite 101, Las Vegas, NV, 89130Nevada Health Centers - Bonanza Clinic #209 - 5001 E. Bonanza Rd Suite 104, Las Vegas, NV, 89110Nevada Health Centers - McDaniel Clinic #601 - 2225 Civic Center Dr. Suite 150, Las Vegas, NV, 89030Nevada Health Centers - Cambridge Clinic #602 - 3900 Cambridge Ave. Suite 202, Las Vegas, NV, 89119Nye County WIC - Tonopah Clinic #406 - 1 Frankee Ave, Tonopah, NV, 89049Nye County WIC - PahrumpClinic #505 - 1981 E. Calvada Blvd. N. Suite 100, Pahrump, NV, 89048Pershing County WIC - Battle Mountain Clinic #403 - 370 S Mountain Street, Battle Mountain, NV 89820Pershing County WIC - Lovelock Clinic #421 - 775 Cornell Street, Lovelock, NV, 89419Pershing County WIC - Winnemucca Clinic #422 - 26 E. Haskell Street, Suite B, Winnemucca, NV, 89445Pershing County WIC - Fallon Clinic #425 - 993 W. Williams Ave., Fallon, NV, 89406Ron Wood Family Resource Center - Carson City Clinic #423 - 2621 Northgate Lane #62, Carson City, NV, 89706St. Rose WIC - Henderson Clinic 720 - 2651 Paseo Verde Pkwy., Suite #180, Henderson, NV, 89074St. Rose WIC - West Clinic #721 - 7220 S. Cimarron Rd. Suite 195, Las Vegas, NV, 89113Sunrise Children's Foundation - Meadows Clinic #501 - 3838 Meadows Lane, Las Vegas, NV, 89107Sunrise Children's Foundation - Sahara Clinic #502 - 1000 E. Sahara Ave. Suite 101, Las Vegas, NV, 89104Sunrise Children's Foundation - N. Las Vegas Clinic #503 - 3601 N Las Vegas Suite 102, Las Vegas, NV, 89115Sunrise Children's Foundation - Mesquite Clinic #504 - 355 W. Mesquite Blvd. Suite D15, Mesquite, NV, 89027Sunrise Children's Foundation - Nellis AFB Clinic #803 - 4311 Carswell Ave., Las Vegas, NV, 89191Urban League WIC - Flamingo Clinic #650 - 6480 W. Flamingo Rd. Suite B, Las Vegas, NV, 89103Urban League WIC - Eastern Clinic #651 - 3320 E. Flamingo Suite 50, Las Vegas, NV, 89121Washoe County WIC - South Reno Clinic #301 - 601 West Moana #3, Reno, NV, 89509Washoe County WIC - Health Dept. Clinic #302 - 1001 East 9th Street, Reno, NV, 89502Washoe County WIC - Incline Clinic #306 - 880 Alder Ave., Room #205, Incline Village, NV, 89451Participant Name* First Last What happened?Describe the IncidentNameThis field is for validation purposes and should be left unchanged.