Wings Foundation, Inc. Assistance Application

Thank you for contacting Wings Foundation. The following application has a check-list to guide you.

"The mission of Wings Foundation is to provide financial grants to American Airlines flight attendants who are in critical need of financial assistance due to illness, injury, or disability; or who sustain damage to their primary residence by a natural disaster or catastrophic event."

Wings endeavors to assist AA mainline flight attendants on the APFA system seniority list who are out of sick time or who is a caregiver for a registered ill dependent with basic living expenses. Wings provides a "bridge" to help cover crucial monthly expenses, including mortgage or rent, utilities, a phone and auto, as well as medical insurance. While we are not always able to cover all monthly expenses, we are able to provide guidance and direction in areas where some expenses might be reviewed to be reduced or eliminated.

Please keep in mind that Wings is not an insurance or disability policy.

To be considered for financial assistance, an American Airlines mainline flight attendant facing an illness, injury, or disability that causes a critical need for financial assistance must meet these requirements:
- Active on the American Airlines APFA System Seniority List
- Five (5) hours or less of Sick Time available
- Presently on the sick/absence list or projected to be removed from service a minimum of forty-five (45) days with medical documentation
- Have less than two (2) months of usable income in checking and/or savings to cover household expenses (Excludes retirement funds)
- Provide a completed Wings application for financial assistance along with supporting documentation outlined in the application checklist
Wings exists through the generosity of your fellow flight attendants and volunteer committee members.

All information is confidential.

Before you can submit your application, make sure you have the following documents available. The application will not be submitted if any documents are missing.
- Completed, Signed Application
- Copies of the Last Three (3) Months of the following Payroll Documents:
  - Last three (3) Months of Payroll Statements (from Applicant and Spouse)
  - Checks Issued History (Full Page - All checks issued to Flight Attendant. Do not provide if Furloughed.)
- Medical documentation
- Copy of page one (1) and two (2) of your previous year 1040 Federal Tax return - Social Security Number redacted
- Copies of your last three (3) checking and savings statements (front and back of all copies).
- Medical Out-of-Pocket expenses (proof of payments)
- Copies of your last three (3) months from the following: Disability, AFLAC Disability, Unemployment Benefits Paychecks, Furlough Paychecks Workman’s Comp, Pensions, Additional Employment Paychecks, and/or Annuity Payments.
- A copy of your last monthly schedule/line block (HI-1).
- 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, Mortgage information/Rental Agreement.)
- Copy of your HISK and HISK/L
- Copy of HI-10 (Only if you are on an Extended Leave of Absence.)
**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, etc.)

For an application to be accepted for consideration, it must be complete and include ALL required documents. All information must be legible. Once the application is signed and received, a Wings case work volunteer will contact you. Any missing documentation will delay the process.

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

Sincerely,

Wings Foundation, Inc.

Revision 2020-08
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 Income

Pensions

Investment Property Income

Fund Me Accounts (ANY TYPE)

AFLAC Disability

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

AFLAC Disability

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 Upload the following Documents
- Copies of the Last Three (3) Months of the folling Payroll Documents: ( Required )
  - Last Three (3) Months of Payroll Statements (from Applicant and Spouse)
  - Checks Issued History (Full Page - All checks issued to Flight Attendant)
- Medical Documentation (See sample of Physician's Letter for required information) ( Required )
- Copy of Page one (1) and Page Two (2) of your previous year 1040 Federal Tax Return - Social Security Number redacted ( Required )
- Copies of your Last Three (3) checking and savings statements (front and back of all copies) ( Required )
- Medical Out-of-Pocket expenses (proof of payment)
- Copies of your last three (3) months from the following:
  - Disability
  - AFLAC Disability
  - Unemployment Benefits Paychecks
  - Furlough Paychecks
  - Workman’s Comp
  - Pensions
  - Additional Employment Paychecks
  - Annuity Payments.
- A copy of your Last Monthly Schedule/Line Block (HI-1) ( Required )
- A copy of the most recent Long Term/Short Term Disability and/or Social Security Disability Statement
- Copies of Loan Statements:
  - Auto Loans
  - Credit Union Loans
  - Mortgage Information or Rental Agreement ( Required )
- Copy of your HISK and HISK/L ( Required )
- Copy of HI-10 ( Required o nly if you are on an Extended Leave of Absence .)
**Only these types of files can be submitted: pdf, doc, docx, xls, xlsx, csv, txt, jpg, jpeg, png, gif**

Revised 2020-08
Last Three (3) Months of Payroll Statements and Checks Issued History of Applicant *

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

Browse Files
You can add all pages here Cancel of
Medical Documentation/Physician's Letter *

Browse Files

Cancel of
Page One and Page Two of 1040 Federal Tax Return *

Browse Files
Please Redact your Social Security Number from Documents Cancel of
Last Three (3) Months of Checking and Savings Statements (All Pages) *

Browse Files

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

Browse Files

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

Browse Files
Proof of Disability, AFLAC Disability, Unemployment Benefits Paychecks, Furlough Paychecks, Workman’s Comp, Pensions, Additional Employment Paychecks, and/or Annuity Payments 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)

Browse Files

Cancel of
Copy of your HISK and HISK/L *

Browse Files

Cancel of
Copy of your HI-10 *

Browse Files
Required if you are on an Extended Leave of Absence 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:

Monthly Household Income & Assets

Monthly Household Expenses