Wings Foundation, Inc. Assistance Application

Wings Foundation, Inc.

Dear Flight Attendant:

Thank you for contacting the Wings Foundation. We realize that this is a difficult time for you and we would like to make applying for assistance as easy as possible. The following application has a check-list to assist you.

“The stated mission of WINGS shall be to form a grassroots volunteer organization that collects and administers funds from and for Flight Attendants on the American Airlines Inc. System Seniority list who are in critical need of financial assistance as a result of illness, injury, or disability; or who are out
of sick time; or who are without disability benefits; or those who have had a catastrophe or disaster which causes major hardship that would justify financial support.”

WINGS endeavors to assist AA flight attendants on the system seniority list who are out of sick time or almost out of sick time or who is a caregiver for a registered ill dependent with basic living expenses.

WINGS Assistance is designed to be a bridge. Please keep in mind that Wings is not an insurance or disability policy.

WINGS, exists through the generosity of your fellow flight attendants and volunteer committee members.

All information is confidential.

Before you can submit your application, please make sure you have the following documents available. The application will not be submitted if any documents are missing. Please have the following:
- Copies of the following Payroll Documents:
  - Last three (3) months of Payroll Statements (From Applicant and Spouse if married, civil union, or domestic partner)
  - Checks Issued History (Full Page - All checks issued to Flight Attendant in the last three (3) months)
- Medical Documentation (Please see sample of Physician's Letter for required information.)
- Medical Out of Pocket expenses (proof of payment) EOB.
- Copies of your last three (3) months of Checking & Savings Statements
- A copy of your last monthly schedule/line block (HI1)
- Mortgage/Rental Agreement
The following are not required to submit your application, however, if these documents are available, please provide these documents:
- A copy of the most recent, Long Term/Short Term Disability and/or Social Security Disability Statement.
- Workman's Comp Statements
- Pension Statements
- Loans:
  - Auto
  - Credit Union
**Only these types of files can be submitted: pdf, doc, docx, xls, xlsx, csv, txt, jpg, jpeg, png, gif**

Additional information may be requested by Wings Foundation, Inc.

Wings Foundation, Inc., reserves the right to verify your documents by contacting the originator(S) of your documents. (ie: leases, rental agreements, ect.)

Please complete the application in its entirety. The information provided must be legible. Once the application is completed, signed, and all required documents is completed, a Case Work Volunteer will contact you to the number you have provided.

If you have any questions regarding the application, please call (817) 571-7083 and leave a message.

Sincerely,

Wings Foundation, Inc.
Click on the Box to show Sample of Physician Letter
Do you have the required documents needed for the application? *

Yes No
Please make sure you have all the required documents we are requesting in order to submit your application for assistance.

Monthly Household Income & Assets

Please answer at least one field on each table that is required. If there is no answer, please type 0 in one field.

Monthly Household Income *

Amount

Average Monthly Salary

Spouse/Partner Salary

Roommate(s) Contribution

Social Security Disability

State Disability

Short/Long Term Disability

Workman's Compensation

Alimony

Unemployment

Child Support Income

Long Term Care Income

Supplement Insurance

Rental Income

Pensions

Other Income

Assets *

Amount

Checking Balance

Savings Balance

Credit Union

Certificate of Deposit (C.D.'s)

Stock

Other Assest

Monthly Household Income Total
Total does not include Assets
Monthly Household Expenses

Please answer at least one field on each table that is required. If there is no answer, please type 0 in one field.

Mortgage/Rent *

Amount

Primary Mortgage/Rent

HOA

Utility Expenses *

Amount

Electric (Heat/AC)

Water/Sewer

Gas/Oil

Phone (Land and/or Cell)

Auto Payment

Automobile Gas/Public Trans

Food

Medical Insurace *

Amount

Health - Primary

Health - Secondary

COBRA

Vision

Dental

Short Term Disability

Long Term Disability

Critical Illness

Life Insurance

Other Insurance

Amount

Home Insurance

Rental Insurance

Car Insurance

Other Expences

Amount

Child Support

Child Care

Medical Expences

Medical Prescriptions (Out of Pocket)

Have you applied for assistance? (Ex: American Family Fund, American Cancer Society, Red Cross, SNAP/Food Stamp Program) *

Yes No
If Yes, name and results: *

0/6000
Have you previously applied to the Wings Foundation for assistance? *

Yes No
If Yes, date(s) and base(s): *

0/6000

Please have the following documents to submit:
- Copies of the following Payroll Documents:
  - Last three (3) Payroll Statements (From Applicant and Spouse if married, civil union, or domestic partner)
  - Checks Issued History (Full Page - All checks issued to Flight Attedant)
- Physican's Letter
- Copies of your last three (3) months of checking and savings statements.
- Medical Out of Pocket expenses (proof of payment) EOB.
- Copies of your last three (3) months from the following:
  - Disability
  - Workman's Comp
  - Pensions
  - Employment Paychecks
- A copy of your last monthly schedule/line block (HI1)
- Mortgage/Rental Agreement
The following are not required to submit your application, however, if these documents are available, please provide these documents:
- A copy of the most recent, Long Term/Short Term Disability and/or Social Security Disability Statement.
- Copies of loan statements (ie: Auto Loans, Credit Union Loans)
**Only these type of files can be accepted: pdf, doc, docx, xls, xlsx, csv, txt, jpg, jpeg, png, gif
Last Three (3) Payroll Statements *

Browse Files
You can add all three here. Cancel of
Last Three (3) Payroll Statements from Spouse *

Browse Files
You can add all three here Cancel of
Physician's Letter *

Browse Files

Cancel of
Last Three (3) Months of Checking and Savings Statements *

Browse Files

Cancel of
Medical Out of Pocket Expenses (Proof of Payment) EOB

Browse Files

Cancel of
Copies of your Last Three (3) Months from the following Below:

Browse Files
Proof of Disability; Workman's Comp; Pensions; Employment Paychecks (Outside AA) Cancel of
Copy of Last Monthly Schedule/Line Block (HI1) *

Browse Files

Cancel of
Mortgage/Rent Agreement *

Browse Files

Cancel of
Most Recent Long Term/Short Term and/or Social Security Disability Statement(s)

Browse Files

Cancel of
Copies of Loans (Auto, Credit Union, etc.)

Browse Files

Cancel of

Collection and use of Personal Information

Your privacy is important. Furnishing us this information is voluntary. The information you provide will be
used to determine if you qualify for assistance. Failing to provide us with all or part of the requested
information may prevent us from making a timely decision on your assistance. Personal information will
be kept confidential. However, your information may be disclosed as required by law or with your
permission.

Conduct

Please be advised that any conduct of a threatening or harassing nature, whether verbal, written or
physical, will not be tolerated. Such conduct directed towards the Wings Foundation or a representative
of the Wings Foundation will result in immediate and permanent termination of assistance. Any such
reported conduct may be referred to American Airlines Security Department or outside law enforcement
for further action.

Gift

Financial assistance received from Wings Foundation, Inc. is a gift made possible by the generosity of your
fellow flight attendants and does not have to be repaid. Wings Foundation, Inc., however, is grateful for
any donation received from an applicant who has been awarded a settlement due to litigation.

Responsibility to update information

It is responsibility of the applicant to keep Wings informed of any changes to your health, work or financial
situation. If approved, you will be asked to make contact with your assigned caseworker at least monthly.

"As a reminder, financial assistance received from Wings Foundation, Inc. is a gift made possible
primarily by the generosity of your fellow American Airlines Flight Attendants and is intended
to pay for medical insurance and allowable living expenses. Any misuse of these funds may
result in the suspension or termination of assistance."
Certification *

I, the undersigned, certify that I have read and understand all the information contained in this application and that all the statements and representations made by me in this application and any accompanying forms are true and correct.
Applicant's Signature *

Clear
Should be Empty:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Name
Address
City	State / Province
Postal / Zip Code	Country

Monthly Household Income & Assets

Monthly Household Expenses