TESTING application

OFFICE USE ONLY: Fee Paid $_____________ Date Paid______________ Belt Size _______ Payment Method ____________ Chosun Black Belt Academy TESTING APPLICATION NAME ____________________________________________ AGE __________ DOB_________________ ADDRESS ________________________________CITY___________________ ZIP _________________ PHONE_________________________________ EMAIL ________________________________________ HEALTH CONCERNS___________________________________________________________________ PRESENT RANK________________ TESTING FOR_________________ TIME IN TAE KWON DO______ [THIS SECTION FOR TESTING JUDGE’S USE ONLY] CURRICULUM SCORE 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 ADDITIONAL COMMENTS STANCES PAL-GWE FORM ALTERNATE FORM(S) TAE GEUK FORM CREATIVE FORM 1 1 1 1 1 9 9 9 9 9 10 10 10 10 10 _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ KICKING TECHNIQUE HANDS TECHNIQUE SPECIAL TECHNIQUE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ COMBINATIONS 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ ONE-STEP SELF-DEFENSE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ CREATIVE SELF-DEFENSE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ GRABBING SELF-DEFENSE1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ ADVANCED SELF-DEFENSE1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ KNIFE SELF-DEFENSE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ MISC. SELF-DEFENSE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ SPARRING 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ BREAKING 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ ORAL/PHILOSOPHY 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ TKD SPIRIT 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ DISCIPLINE/ETTIQUETTE 1 2 3 4 5 6 7 8 9 10 _______________________________________________________________ **If under 18, you must receive permission to test from your parents and teacher/counselor from school.** For school teacher/counselor: This student has been performing satisfactorily both academically and behaviorally. (Circle one) AGREE _____________________________ DISAGREE _______________________________________ PRINT NAME SIGNATURE ________________ DATE For Parents of member: My son/daughter has been listening well and behaving as expected at home. (Cirlce one) AGREE _____________________________ PRINT NAME DISAGREE _______________________________________ SIGNATURE ________________ DATE