Get Financial Hardship Application - Bridge Builders Counseling

This guide is designed to assist users in completing the FINANCIAL HARDSHIP APPLICATION for Bridge Builders Counseling. Follow the outlined steps to ensure that you fill out the application accurately and completely.

Follow the steps to successfully complete the application online.

1. Click ‘Get Form’ button to obtain the application and open it in your preferred document viewer.
2. Fill out your account number (for office use only) if applicable, followed by your last name, first name, and middle name.
3. Enter your date of birth in the required format (MM/DD/YYYY) and your social security number.
4. Complete your home address, including any apartment number, city, state, and zip code.
5. Provide your home phone number, work phone number, and any additional contact information.
6. Indicate your insurance status by checking the appropriate box – whether you have insurance or not. If you have insurance, fill in the details for your primary and secondary insurance including the ID numbers.
7. Specify your employment status by selecting one of the options: employed, unemployed, retired, or disabled. If unemployed, indicate how long you have been in that status.
8. State the number of family members or others living in your household.
9. Briefly explain the reasons for your inability to pay your medical bills.
10. Use the attached worksheet to list your monthly income and monthly debt.
11. Select two of the required supporting documents to submit, such as pay-stubs, bank statements, or tax returns.
12. Certify the accuracy of the information provided by signing and dating the application.
13. Once completed, save your changes and download the application. You may also print it out or share it as needed.

Complete your FINANCIAL HARDSHIP APPLICATION online to access the assistance you need.