Complaint Against WIC Participant at Farmers' Market Anonymity I would like to be anonymous Witness Contact InformationYour name and at least ONE contact method is needed for the State Office to follow up on this complaint. If 'anonymous' is selected, we will not share your information.Name* First Last Phone NumberEmail Complaint TypeYou may check up to four (4) complaint types.* Attempting to purchase foods not approved by WIC Threatening or verbally abusive towards farmer, market attendees Physically abusive towards towards farmer, market attendees Causing vendor/market disruption Inappropriate use of WIC coupons (no signature, using early) Exchanging WIC coupons for credit or non-food items Altering coupons; counterfeit coupons Stealing WIC coupons Stealing food or other farmers' market items Other (Please describe below) Complaint InformationDate of Incident* MM slash DD slash YYYY Time of Incident : Hours Minutes AM PM AM/PM Participant Name* First Last What happened?Describe the IncidentPhoneThis field is for validation purposes and should be left unchanged. Δ