Number: (ITF USE ONLY)

INTERNATIONAL

TAEKWON-DO FEDERATION

APPLICATION FOR DEGREE CERTIFICATE

APPLICANT:
a

FORENAME

SURNAME

Mr / Mrs / Miss

HOUSE / APT STREET

NAO or INO Number * STATUS CARD No. * PLACE OF BIRTH

TOWN CITY ZIP COUNTRY OCCUPATION EDUCATION

NATIONALITY * DATE OF BIRTH HEIGHT WEIGHT EYE COLOUR HAIR COLOUR

DD/MM/YYYY

DEGREE APPLIED FOR

For IVth Degree Only
a

GRADING DATE
DAY/MONTH/YEAR

LOCATION

DATE HISTORY / THESIS SENT

Current Certification:
a

INSTRUCTOR Degree Signature: EXAMINER Degree DATE

DAY/MONTH/YEAR DAY/MONTH/YEAR

ITF CERTIFICATE NUMBER Months since last grading

Courses Attended: (If necessary continue overleaf)
a

CERTIFICATE NUMBER

Signature: ASSOCIATION PRESIDENT / AUTHORISED DEPUTY Degree Signature: DATE SIGNED

DAY/MONTH/YEAR

AFFIX CURRENT PHOTO

Affix one photograph to the left where indicated.

* Please see guidance notes over leaf.

The Society for Orthodox Taekwon-Do is registered as a non-profit organisation. ITF Administration: 192 High Street, 1st Floor, West Drayton, Middx. UB7 7BE ENGLAND Tel. 00 44 1895 459946 Fax. 00 44 1895 430257 secgen@itf-administration.com www. itf-administration.com

GUIDANCE FOR APPLICANTS

Please ensure that all items are appropriately & accurately completed. It is requested that all details are typewritten. (PC templates are available on request from ITF H/O if required). If this form is hand written, the ITF will not be responsible for any certificate printing errors and replacement/amended certificates will be charged at $30.00. Only one nationality should be entered, that being the nationality stated in the applicants passport. In the case of the applicant having dual nationality, only the nationality that most accurately reflects the applicants citizenship should be entered. Only one forename & surname should be entered as there is not usually enough room for more on the certificate. If more than one is entered, without any explanation provided, the certificate may not be printed with the entire name. The ITF will not be responsible if this occurs and replacement/amended certificates will be charged at 30.00. N.A.O. or N.O. Number refers to the registration number of either the Nationally Amalgamated Organisation or National Organisation (as appropriate) of which the applicant is a current & paid up member. Every black-belt must have a current status card. Thos without a valid status card are not permitted to grade. Personal history & thesis are requirements for grading to IVth Degree. These should be submitted to the ITF at least 3 months in advance of the grading date for approval. The thesis should be about Taekwon-do. It could be what you think about Taekwondo at the present, or how you see it developing in the future. Alternatively it could be about any part of Taekwon-do such as warming up exercises or patterns. It could also be about the anatomy in connection with Taekwon-do. Failure to comply with any requirement will result in permission either being withheld or withdrawn for you test.