Application For Hurricane Harvey Financial Assistance

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Southern Smoke is a nonprofit 501c3 charitable foundation. In 2017, we partnered with Legacy Community Health to address what we knew would be an urgent need for so many. Southern Smoke is dedicated to raising money and, with the help of Legacy Community Health, to distributing those funds raised to individuals that are employed or operate a business in the culinary and/ or beverage industry, including restaurant and bar suppliers (i.e. ranchers, farmers, drivers for food supply, breweries, etc.). We stand with those in our community and are committed to giving to those affected by the nation’s largest natural disaster to date.

Application Verification and Award Process: Each application will be verified by a committee of volunteers. Once verified all personal information will be removed and the application will be forwarded to a separate Awards Committee. The Awards Committee will be made up of community members from various and diverse backgrounds and professions. The Awards Committee will select awardees by vote. Awards will be designated in $1,000.00 increments. No awardee will be granted more than 10,000.00 and all funds granted will be taxed accordingly.

Please fill out the following application if you believe you meet the necessary criteria for Southern Smoke’s Hurricane Harvey relief grant. Please only apply if you did not have flood insurance between August 25 and 29, 2017, meet one of the following criteria and have been negatively affected by Hurricane Harvey:

Completed applications must be submitted by October 23, 2017 to be considered.

Application Requirements

All applications require:

  • Completed Statement of Need
  • Completed Personal info worksheet
  • Completed Employment History
  • Submitted copies of both recent and pre-Hurricane paycheck or paystub, lease or mortgage statement, utility bills
  • Photos of damage(s)

Applications should also include:

  • Completed Worker Stability Survey
  • Other materials you think we should know about your experience of loss from Hurricane Harvey (i.e. doctor's notes, HOA notices, FEMA letters, etc.)

Statement of need: Please briefly describe the damage to your property and/ or loss of income that has occurred as a result of Hurricane Harvey. This may be completed by applicant or by someone on applicant’s behalf. The statement must be included to be considered. Please include any of the following within your statement if applicable:

  • How has this hardship affected you financially (general statement)?
  • How much work have you missed as a result of Hurricane Harvey? If applying for income reimbursement, please include your last three (3) paystubs. If you do not have copies of your paystubs, include contact information for your most recent employer.
  • Any loss or damage to personal property
  • Any loss or damage to personally owned business
  • Injury or Loss of life
  • And other unforeseen expenses due to Hurricane Harvey including medical expenses, childcare expenses, etc.
Please Limit to 200 Words

Personal Info for Applicant

Food, Beverage or Service Provider Employment History

Please provide the past 6 months of employment history, starting with the most recent/current:

*Employer must be in the Houston area in order for applicant to be considered

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Information for current job only:

If your current employer offers an emergency assistance program, please provide a contact to verify coverage if you have or will apply:

Financial Worksheet for Direct Grant Application

List everyone who lives in your home including yourself.

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Monthly Household Income (average, after taxes, amount you take home each month).

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Monthly Debt Payments (Your responsibility).

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Monthly Living Expenses

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Worker Stability Survey

Please fill out to the best of your ability. Information will be used to verify applicants only and will not be shared and will not be used by Awards Committee.


Please select the best answer for each item:

Are you receiving any of the public assistance listed below?

Applications should be submitted online if possible. If applications need to be mailed please send to:

427 W. 26th Street
Houston, Texas 77008

Please do NOT drop off in person.

If you have questions about your application and/ or the application process, please contact:

Kathryn Lott
Executive Director, Southern Smoke
Kathryn@southernsmoke.org

Completed applications must be submitted by October 23, 2017 to be considered.