Disaster Intake: Severe Weather in the Upstate
Have you been affected by the recent tornadoes or flooding in the Upsate?
This form is designed to help us better understand disaster related needs in the upstate. Please call 211 or visit
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.
Thank you. Please let us know how you have been affected by the storm.
Loss of food
Other damage to home or property
Please describe how you were impacted by the storm below
Do you own or rent your property?
Was your property insured at time of the damage?
Thank you. While we will not be able to contact you if additional assistance becomes available, you may call 211 or visit
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)
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.
Address Line 1
Address Line 2
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.