CAREER

The nature, duration and success of your involvement with or your contribution to the sport of rodeo

INCIDENT

The nature and severity of your injury

WORK

Your ability to do work other than rodeo to support you and/or your family

SUPPORT

The extent to which you have other means of support

FINANCE

Your current assets and liabilities

PLEASE READ THIS BEFORE FILLING OUT APPLICATION

Below is the digital application for the Justin Cowboy Crisis Fund. Please fill it out as completely as possible and include any additional information that may assist the JCCF Board of Directors in reviewing your case. The Justin Cowboy Crisis Fund was created to provide need based financial assistance to rodeo professionals injured through their participation in the sport.

Assistance is not retroactive and if you qualify for assistance, it will be awarded based on the date your application is received, not your injury date. Additionally, JCCF is designed to help individuals and their families through a crisis situation and the maximum period of assistance is 12 months. It is an extensive review process and it may take a period of time to evaluate your application. You will be contacted when the process is complete. The fund does not cover medical bills but assists with basic monthly living expenses for those who qualify.

The Board of Directors consider the following when awarding assistance:

The duration and success of your involvement with or your contribution to the sport of rodeo
The nature and severity of your injury
Your ability to do work other than rodeo to support you and/or your family
The amount of financial support you may receive from family and/or other sources
Your current assets and liabilities

Your case will not be reviewed until we receive the (1) fully completed application and (2) the completed Physician statement from your doctor, available for download below. If you applied to another organization for assistance, JCCF will not process your application until the other organization(s) review your case and make a final decision. The fund is in regular contact with other groups that provide assistance.

If approved for assistance, JCCF utilizes ACH direct deposit to send the funds. You will be required to provide a voided check to us to set up the direct deposit.

Please keep a copy of your application so if we contact you with questions you can refer to it. If you have any questions regarding the application or the Justin Cowboy Crisis Fund, call (719) 528-4726 or e-mail jccfinfo@prorodeo.com.

ONLINE JCCF ApplicatioN

Step 1
Please fill out the JCCF Application online below or obtain the printable version by downloading it, here.

Step 2
Download the Physician statement for your doctor to complete and return, here.

This digital application is in trial format. You are welcome to complete it

with the understanding that additional information may be required.

First Name

Middle Name

Last Name

Email Address

Phone Number

Date of Birth

Current Age

Mailing Address

PRCA or WPRA Card Number

If approved for assistance, I authorize JCCF to use my image in fundraising and promotional materials.

Spouse Name

List age of children, and any special needs or health considerations

Please provide the count of rodeos you've participated in and the total earnings from all rodeos associated with any organization in the last two years

If yes, what is your occupation?

If no, when will you be able to return to this job if currently unable, and what is the reason for the inability?

Rodeo Income (average PER MONTH before injury)

Non-Rodeo Income (PER MONTH) other employment)

Income from spouse’s job (if you stated that your spouse has a job, this field must be completed)?

If sponosor income is received, how is it paid out (monthly, quarterly, yearly)?

Have you received any sponsor income as of the date of this application? If yes, please specify the amount.

If sponsor income is pending, will your injury impede the sponsor from making payments this year? If so, please specify the amount that will not be paid.

Do you receive income from savings accounts, money market accounts, certificates of deposit (CDs), or other investment accounts? Pease describe.

What other contributions are there to your income? Are there any other family members adding to your household income? Please list the monthly amount.

Total Monthly Income, total of amounts listed above

Monthly rent or mortgage amount

Monthly food amount

Monthly animal feed amount

Monthly Utilities - Electric/Gas/Propane/Etc. amount

Monthly Utilities - Water amount

Monthly Utilities - Phone (home & cell) amount

Monthly Insurance - Life amount

Monthly Insurance - Medical amount

Monthly Insurance - Animal amount

Monthly Insurance - Auto amount

Monthly Insurance - Home amount

Monthly Insurance - Other amount

Total Monthly Expenses, total of amounts listed above

Assets | Checking Account(s), current balance

Assets | Saving(s) Account(s), current balance

Assets | C/D's, current balance

Assets | Retirement savings (IRA’s, 401K, etc.), current balance

Assets | Other security investments, current balance

Assets | Life Insurance, Face value

Assets | Life Insurance, Surrender value

Assets | Auto 1 - Year & Make

Assets | Auto 2 - Year & Make

Assets | Auto 3 - Year & Make

Assets | Trailers/Equipment - Please describe

Assets | Auto 1 - Value

Assets | Auto 2 - Value

Assets | Auto 3 - Value

Assets | Trailers/Equipment - Value

Assets | Real Estate Home - Current Value

Assets | Real Estate Land - Current Value

Assets | Real Estate Other - Please describe, Current Value

Assets | Personal Property (Describe & List Value)

Total Assets, total of asset amounts listed above

Liabilities | Home Mortgage, current value

Liabilities | Other Mortgage, describe, current value

Liabilities | Auto 1 - Year & Make

Liabilities | Auto 1 - Total Owed

Liabilities | Auto 2 - Year & Make

Liabilities | Auto 2 - Total Owed

Liabilities | Auto 3 - Year & Make

Liabilities | Auto 3 - Total Owed

Liabilities | Credit Card 1 - Name

Liabilities | Credit Card 1 - Total Owed

Liabilities | Credit Card 3 - Name

Liabilities | Credit Card 3 - Total Owed

Liabilities | Loan 1 - Describe

Liabilities | Loan 1 - Total Owed

Liabilities | Loan 3 - Describe

Liabilities | Loan 3 - Total Owed

Liabilities | Other Debts 1 - Describe

Liabilities | Other Debts 1 - Total Owed

Liabilities | Other Debts 3 - Describe

Liabilities | Other Debts 3 - Total Owed

Liabilities | Credit Card 2 - Name

Liabilities | Credit Card 2 - Total Owed

Liabilities | Credit Card 4 - Name

Liabilities | Credit Card 4 - Total Owed

Liabilities | Loan 2 - Describe

Liabilities | Loan 2 - Total Owed

Liabilities | Loan 4 - Describe

Liabilities | Loan 4 - Total Owed

Liabilities | Other Debts 2 - Describe

Liabilities | Other Debts 2 - Total Owed

Liabilities | Other Debts 4 - Describe

Liabilities | Other Debts 4 - Total Owed

Total Liabilities, total of liability amounts listed above

Describe your injury in detail?

How did this injury happen?

When did this injury happen?

Where did this injury happen (please list name of rodeo and city, state)?

How long will be you unable to participate in rodeo?

How long will you be unable to work your non-rodeo job, if applicable?

Kindly provide the date when you applied for assistance from the mentioned funds and indicate the current status of your application with them as of the submission of your JCCF application. We are in contact with these organizations and will validate the information.

If a crowdfunding fundraiser (i.e. GoFundMe) has been initiated, kindly share the fundraiser's name along with the current amount raised.

Have you been receiving personal donations from family, friends, and rodeo fans in response to your injury? If so, list an update on the total amount received as of today?

If there is any additional information you would like us to know, please list it below.

I acknowledge that alongside submitting this application, it is required for me to provide the Physician Statement, duly completed by my treating physician. I understand that the processing of my application will not commence until both the application and the Physician Statement are submitted. You may upload the Physcian Statement and Doctor reports below or email them to: jccfinfo@prorodeo.com

Upload File

I agree that this application has been filled out correctly and all information contained is true to the best of my knowledge. I have no assets or resources other than those disclosed in this application for myself and/or my spouse. If assistance is furnished as a result of this application, I agree to notify the Justin Cowboy Crisis Fund of any changes in status with respect to property or income. I hereby authorize any person, firm, corporation, agency, or institution to furnish the Justin Cowboy Crisis Fund any and all information in it’s possession relating to my assets, deposits, dealings or business of any kind whatsoever, or concerning any matter which the Justin Cowboy Crisis Fund may desire.

I understand that this digital application is in trial format and I may be required to submit additional information.

Your Signature

Today's Date

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