If you or an amputee you know needs financial assistance, please download, print off, fill out the following form and send it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Financial Assistance (.pdf)
Guidelines for Financial Assistance (.pdf) 

Guidelines for Financial Assistance

• The mission of Ye Notorious Krewe of the Peg Leg Pirate, Inc. is to provide assistance to amputees, families of amputees and organizations that work with amputees.
  
  
• No distinction is made with regard to race, color, religion, sex, national origin, age, marital status, personal appearance, or sexual orientation when deciding on awards of financial assistance.
  
  
• The goal of the Financial Assistance Award is to provide equipment and/or services that will enhance the quality of life for the applicant.

Documentation Needed for a Financial Assistance Award (The following will be required by all applicants before the application packet will be considered):

• A total of 2 recommendations - one from a physical therapist, doctor or medical provider, or another organization that works with amputees recommending assistance and one from an adult who can speak to the applicant's character (teacher, religious leader, etc.)
  
  
• Document that there is a financial need that cannot be met by the amputee and/or the family.
  
  
• An essay describing your future goals (not to exceed 300 words).
  
  
• A completed application.

Once the Application is completed, please mail the application and all supporting documentation to:

Ye Notorious Krewe of the Peg Leg Pirate
PO Box 1854
Ruskin, FL 33575-1854