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Rank Certification
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Rank Certification
APPLICATION FOR RANK CERTIFICATION
If you would prefer, download and fill out the application
HERE
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MM slash DD slash YYYY
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MM slash DD slash YYYY
Present Rank Instructor Information
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1st Dan
2nd Dan
3rd Dan
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Desired Rank
*
Color Belt
Black Belt
10th GUP
9th GUP
8th GUP
7th GUP
6th GUP
5th GUP
4th GUP
3rd GUP
2nd GUP
1st GUP
1st Dan
2nd Dan
3rd Dan
4th Dan
6th Dan
7th Dan
8th Dan
9th Dan
Digital Signature and Agreement
*
I certify the accuracy of the above information and agree to abide by the rules of the USTA.
USTA Membership #
*
Rank Certification #
Color Belt Certification Fee: $25
Black Belt Certification Fees:
1st Dan - $300
2nd Dan - $350
3rd Dan - $400
4th Dan - $450
5th Dan - $500
6th Dan - $550
7th Dan - $600
8th Dan - $650
Please make check payable to Chosun Taekwondo Academy and send to:
USTA c/o Chosun Taekwondo Academy
60 Galloway Road
P.O. Box 721
Warwick, NY 10990
Examiner’s Use Only (see notes)
Examined By
Examiner's Rank
Date
USTA Instructor Certification #
USTA Rank & Certification #
School Name & Address
->
Additional Comments
->
Rank Applicant Promoted To
Examiner’s Signature
Notes:
1. Testing/Certification Fees- Black Belt fees Vary with Rank, Please Call, Write or e-mail
2. Black Belt Certification Requires 2 Passport Photos (2 x 2) of Yourself
3. If applying for Certification Directly to the USTA Due to the Absence of a Certified Examiner, also enclose:
    A. Supportive Documents of Your Present Rank (a copy of Dan Certificate)
    B. Resume Detailing Your Martial Arts Training, Rank and Achievement History
4. Non-Black Belt (all levels of color belts), Rank & Certification Fee: $25 (enclose a copy of gup/color belt certification).
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