TESTING application 2 (PDF)

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