Emergency Relief Program

Application For Financial Assistance

Haga clic aquí para la aplicación en Español >

Southern Smoke is a nonprofit 501c3 charitable foundation. Our Emergency Relief Program provides emergency funding to those employed by or own restaurants or bars or are employed by a restaurant or bar supplier that are faced unforeseen expenses that cannot or will not be covered by insurance. We stand with those in our community and are committed to “taking care of our own”.

Application Verification and Award process: Each application will be verified by the Executive Director or a committee of volunteers. Once applications are verified, the application will be distributed to a separate Awards Committee. The Awards Committee will be made up of trusted community members. The Awards Committee will select awardees by vote and will determine the awarded amount to be distributed. All funds granted are subject to taxation to the greatest extent of the law.

Please fill out the following application if you believe you meet the necessary criteria for Southern Smoke’s Emergency Relief Fund. Please only apply if insurance is not providing you with compensation for your emergency and you meet at least one of the following criteria:

Application Requirements

  • Completed Statement of Need
  • Completed Personal info worksheet
  • Completed Employment History
  • Completed Worker Stability Survey
  • Submitted copies of current and *previous paychecks or paystubs, lease or mortgage statement, utility bills (*before the incident that lead to the need for emergency funding)
  • Photos of any damage(s) if applicable
  • Other materials you think we should know about your experience of loss (i.e. doctors bills, HOA notices, FEMA letters, repair estimates, etc.)

Statement of need: Please describe your reason for applying for emergency funding including loss of income and/or additional expenses you have incurred. This may be completed by applicant or by someone on behalf of the applicant. 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? 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 including medical expenses, childcare expenses, etc.
Please be as descriptive as possible

Personal Info for Applicant

Current Mailing Address: If you are granted funding by Southern Smoke Foundation, payment will be mailed to the address you provide below. Southern Smoke will not be responsible for cancelling checks if the payment is not received due to a change in address (unless we are notified in advance of mailing) or incorrect information is provided.

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

Add Another

Information for current job only:

If so, have you applied for assistance through your employer and, if so, how much have you applied for?:

Financial Worksheet for Direct Grant Application

List everyone who lives in your home including yourself.

Add Another

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

$
$
$
$
$
$
$

Monthly Debt Payments (Your responsibility).

$
$
$
$
$
$
$

Monthly Living Expenses

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

Worker Stability Survey

Please fill out to the best of your ability.

Please select the best answer for each item:

Are you receiving any of the public assistance listed below?

Applications must be submitted online.

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

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

Thank you, your application has been sent.
Sorry, your application failed to send.