Disaster Intake: Severe Weather in the Upstate
Have you been affected by the recent tornadoes or flooding in the Upstate?
Yes
No
SC211.ORG
This form is designed to help us better understand disaster related needs in the upstate. Please call 211 or visit
SC211.ORG
to find additional resources, such as rent, food, and utility assistance.
Would you be willing to complete a brief intake form to help us understand the type of assistance you may need? This information would be shared with our trusted partners, who would reach out to you directly if any additional assistance becomes available.
Yes
No thanks
Thank you. Please let us know how you have been affected by the storm.
Loss of food
Roof damage
Water damage
Vehicle damage
Other damage to home or property
Other
Please describe how you were impacted by the storm below
Do you own or rent your property?
Own
Rent
Other
Was your property insured at time of the damage?
Yes
No
Not Sure
SC211.ORG
Thank you. While we will not be able to contact you if additional assistance becomes available, you may call 211 or visit
SC211.ORG
at any time to see what kind of help might be available now.
Please let us know what type of assistance you may need
Home repair (roof, windows, wall)
Home clean up (flood damage, etc.)
Other clean up (trash and other debris in the yard)
Tree removal
Moving expenses
Food assistance
Other
Please describe the type of assistance you need
Thank you for providing this information. Please let us know who we should contact if any assistance becomes available or if we just need to learn a little more about your unique needs.
First Name
Last Name
Phone
Email
Address Line 1
Address Line 2
City
Postal Code
Thank you. One of our trusted partners will reach out to the contact above if any assistance becomes available or if we need to collect a little more information about your specific situation.
Please submit your survey now.