COOKING UP HOPE

Hardship Assistance Request Form

What Situations Qualify

We offer support for:

Illness or injury — affecting you or your close family
Natural disasters — floods, fires, storms, etc.
Loss of a loved one

Emergency hardship:

Unforeseen loss of income
End of government/public assistance
Uninhabitable housing
Utilities close to shutoff

Close family includes spouse/partner, parent, guardian, sibling, or dependent.

Applicant Information

First name

Last name

Personal Email Address

Phone Number

Store Number

Job Title

Required Documentation

Attach documentation that supports your application. Examples include:

Medical bills or letters
Death certificate or obituary
Government letter ending assistance
Photos of housing conditions
Utility shut-off notices

(Attach files or note how they will be submitted)

Crisis or Emergency Details

Which emergency situation has caused you financial hardship?

Illness or injury (self or close family)

Natural disaster (fire, flood, etc.)

Death of a close family member

Emergency hardship (e.g., sudden loss of income, housing issues, utilities at risk)

(Select one or more)

Date the situation began:

Please describe the emergency situation and how it has affected you financially: (Use the space below or attach a separate document if needed)

Eligibility Checklist

Please confirm that all the following apply to you:

I am currently employed in the state of Texas

I have been employed for at least 6 months

I work for San Antonio Wings, Inc., Pizza Patrón, Inc., or San Antonio Restaurant Group Payroll, LLC

I am in good standing with my employer

The event or hardship occurred within the last 60 days

I have not received Cooking Up Hope (or equivalent) assistance in the last 12 months

Certification & Agreement

By signing below, I confirm that:

All information provided in and with this application is accurate and truthful to the best of my knowledge.
I understand that knowingly submitting false or misleading information may result in penalties under applicable state and federal laws.
I understand that submitting this form does not guarantee support, but serves as a formal request for assistance through the Cooking Up Hope program.

I give permission to Rise Up Restaurants and its designated representatives to collect and review all information necessary to evaluate this application. This may include, but is not limited to:

My employment status, salary, benefits, and insurance information
Any other data relevant to this request

I also voluntarily waive my privacy rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for the purposes of releasing health-related information that may apply to this request.

This consent for information sharing and waiver of privacy will automatically expire once the requested information has been disclosed or 180 days from the date of signing, whichever comes first.

I have read and understand this agreement and acknowledge the potential consequences of submitting false or inaccurate information.

I agree to the terms above

Date picker

Apply for Support

Your contact information
Store number + job title
A brief explanation of your hardship
The date of the incident
Documents (e.g. medical bills, notices, letters, photos)