Testing Application

Please fill out the information and complete the requirements. Make sure to print this out and hand it to your instructor one week before the test.


Name_______________________________________________________________________________________________

Current Rank White Belt

Testing for White Belt Blue Stripe

PARENTS PLEASE FILL OUT BELOW (ADULTS IGNORE)
Children: Behavior at home

Children: Behavior in school

Areas than need improvement:_____________________________________________________________________

CHECKLIST

1) Print out this form and complete it.

2) Take the Quiz in this course and PRINT the certificate after passing and ATTACH it to this form.

3) Hand in both this form and your certificate plus the $25 Testing fee to your instructor

ONE WEEK BEFORE TESTING.

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To be filled out by your instructor:

Attended most their classes for two months Y/N

Has trained for a minimum of two months since the last belt promotion Y/N

Self Defense vs Push: FAIL – NEEDS IMPROVEMENT – PASS

Basic Stances : FAIL – NEEDS IMPROVEMENT – PASS

Basic Blocks : FAIL – NEEDS IMPROVEMENT – PASS

Basic Hand strikes : FAIL – NEEDS IMPROVEMENT – PASS

Basic Kicks : FAIL – NEEDS IMPROVEMENT – PASS

Kyok Pa : FAIL – NEEDS IMPROVEMENT – PASS

One Step Sparring : FAIL – NEEDS IMPROVEMENT – PASS

Form : FAIL – NEEDS IMPROVEMENT – PASS

Notes:

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Examiner:___________________________________________________________________________