HARDSHIP

/ Hardship

YOU MUST HAVE A VALID CREW MEMBER NUMBER TO USE THIS FORM. IF YOU ARE A SPOUSE REQUESTING A HARDSHIP, PLEASE E-MAIL US AT BPFBOARD@BLUEPILOTFUND.ORG.

HARDSHIP REQUEST

Hardship Request

"*" indicates required fields

Personal Information

Crewmember Number*

Name*

Date of Hire*

xx/xx/xxxx

Employment Status*

Birthdate*

xx/xx/xxxx

Disability Status*

Contact Information

Mobile Phone*

Work Email*

Non_JetBlue Email*

Home Address

Street Address*

City*

State/Province*

Zip/Postal Code*

Family Information

Emergency Contact*

Contact Phone*

Spousal Employment*

Spousal Income*

Enter 0 if NA

Dependent Children / Parents*

Hardship Information

Financial Impact*

Expected Until Date*

xx/xx/xxxx

Bankruptcy*

Civil or Criminal Defense*

Description*

Income

Legal, Inheritance, Gifts*

Monthly Pension Income*

Monthly Military Reserve Pay*

Other Business Income*

Non Business Income*

Insurance Income

STD/LTD Monthly Disability*

ALPA Monthly Disability*

Other Monthly Insurance*

Monthly Workers' Comp*

Expenses

Housing*

Mortgage/Rent*

Housing Expenses*

Utilities/Etc

Home Food Expenses*

Car Payments*

Childcare*

Insurance Expenses*

Phone Expenses*

Internet*

TV/Streaming*

MISC Expenses*

Medical Debt*

Alimony/Child Support*

Professional Expenses*

Uber/Lyft/Transportation/Fees/Etc

Crashpad/Hotels*

Assets

Savings*

Retirement Assets*

Investment Assets*

Seconday Properties

Property

Boat

Motorcycle

Rental Property

Airplane

Comments

This field is for validation purposes and should be left unchanged.

Contact Information