FFWF Hardship Request Form

YOUR NAME *

First

Last

YOUR HOME ADDRESS *

Address Line 1

City

State

Zip Code

YOUR PHONE NUMBER *

YOUR EMAIL ADDRESS *

UNION MEMBERSHIP *

NAME OF UNION MEMBER *

First

Last

UNION MEMBER'S RELATIONSHIP TO YOU *

Please describe union member's relationship to you

UNION NAME and UNION LOCAL # *

For example, OPEIU 8

UNION CONTACT *

Please provide the name and phone number of a contact at your (or your family member’s) local union.

Number of people in your household *

Where Assistance Is Needed *

Keep in mind that assistance is limited to $500 per household, and is based on funding availability. Average assistance awarded is $200-$300.

Attach copy of bill(s) *

Click or drag a file to this area to upload.

You do not need to list/attach all expenses, just specific item(s) you need help with.

Please explain your hardship in detail and prioritize your greatest needs *

Today's date *