KukKiWon and W.T.
F
Application for Belt Promotion Test
Please circle one: Please circle one:
Name:____________________________________ Age: ________ Male / Female Child /Junior /Adult
Applicant
Desired Belt:_______________________________________________________
Current Belt:_______________________________________________________
Desired Red uniform Size:____
Testing Day :________________________Time :_________:__________ Only High blue belt(blue-red stripe)
Uniform is mandatory for testing. Please, no summer uniforms!
Green belt& UP PLEASE REMEMBER TO BRING
ALLSPARRING EQUIPMENT TO TEST.
PAYMENT Initials: Only check and cash
RECEIVED
DATE: Amount:
/ / $
CK# CASH Signature:
*Test Fee: CASH or CHECK □ $55 – If Paid by Deadline □ $60 – If Paid after Deadline
*Private Test Fee: CASH or CHECK □ $60
For Masters use only.
Test SCORING
EVENT MENTAL, SPIRITUAL, AND PHYSICAL STATE Points
Name SYSTEM
Coordination, Breath Control, Balance, Stance, Focus, A+ Perfect
FORM
and Composure A
Concentration, Confidence, Composure, Timing, Excellent
SELF-DEFENSE
Speed, and Execution B+ Great
KICK OR Composure, Control, Speed, Balance, Accuracy, B
FREE SPARRING Confidence, and KI-HAP! Average
BREAKING Confidence, Power, Speed, Focus, Accuracy, and KI-
TECHNIQUE HAP! C Fair
D Re-
Test
Olympic TaekwondoAcademy is affiliated with: United States TKD Union, Group A Member of US, Olympic Committee, and Members of Pan/American
TKD Union.
Comments:
I, as student/guardian, submit this for a promotion test in accordance I hereby declare the person above is eligible to be promoted in a test conducted
with the promotion regulations of the Kukkiwon / WTF. by the World Taekwondo Federation at Olympic Taekwondo Academy.
______________________________________________________ ___________________________________________________________
Student or Guardian’s Signature Grand Master
Judge’s Signature: _________________________
RED TAPE :
928 Hopmeadow Street, Simsbury, CT 06070
860-988-0096
www.olympictaekwondoacademy.com
Dear Parent:
In order to become more familiar with our students please take a couple of minutes and fill out the bottom portion of this
form. When you are done return this with the test application.
Box 1:
We ask that you give us 2 examples of good behavior your child displays at home or school. (i.e. “John” helped with dishes
last week or “John” fought less with his sister.)
Box 2:
We ask that you give us 2 examples of how your child can improve at home or at school. Please list any improvements you
have seen in your student since beginning Tae Kwon Do. (i.e. I would like “Jane” to make her bed in the morning. Or “Jane”
needs to study more to make better grades.)
Box 3:
This is the box to “grade” your child’s overall behavior. Please mark accordingly and place the red tape on their belt or
uniform.
Behavior 1 2 3 4 5 6
Attitude 1 2 3 4 5 6
Cooperativeness 1 2 3 4 5 6
Respect for others 1 2 3 4 5 6
Overall rating 1 2 3 4 5 6
Excellent Very Good Good Average Poor Very Poor
