UTA Black Belt Test

Spring of 2012 United Taekwondo Association Black Belt Examination
Saturday, March 17, 2012
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! ! ! ! February 1, 2012
Dear Promotion Applicant, ! Thank you for your choice to participate in the 2011 United Taekwondo Association Black Belt Promotion Exam. As an association, we are looking forward to hosting Black Belts from all over the United States to participate in this event. Hosted by Grandmaster Kyongwon Ahn, this day will surely prove to be both a prestigious and historical event. We are excited that you have chosen to take part. ! In this packet, you will nd several pages of information. Please take the time to read through and complete all necessary information. ! As always, each applicant will be required to complete a United Taekwondo Association Application for Black Belt Promotion. In addition, please complete a UTA Promotion Application (in triplicate if testing for a Dan/Poom). You will also nd an order form for unique items that will be offered for this event. As special certicates are being offered and programs are being printed, we ask that all applications be submitted to the main school no later than Saturday, February 17th. ! If you have any questions regarding the information that has been provided, please dont hesitate to contact the main school at (513) 791-8888 or by email: ahntkd@earthlink.net. We will look forward to seeing you in March. Sincerely,
David Hamilton Executive Director, United Taekwondo Association
United Taekwondo Association

Application for Black Belt Promotion
Please complete the following application for consideration to be tested for the rank of 1st Dan/Poom or higher. All late applications will be denied. Name: ______________________________________! DOB: ______/_____/______
Address: ___________________________________________________________________ City: _____________________! State: _____!Zip: _________! Present Grade: ____________________ Phone: ______________
Desired Grade: __________________ Belt Size: ___________
Test Date: ______/_____/______
Branch: ______________________________ Instructor: ___________________________ Experience: Years of Taekwondo experience: _____________ Date of last promotion: ______/_____/______ Rank received: _____________ (If applicable) Dates of past credit tests: ______/_____/______ ______/_____/______ ______/_____/______ ______/_____/______ ______/_____/______ ______/_____/______ ______/_____/______ ______/_____/______
If applying for time credit (see UTA guidelines), please list national championships, etc. below:
Supplemental Information: Please supply a brief description of your thesis topic. Attach a copy of thesis to this application.
Please list your major achievements and contribution activities (especially for the development of Taekwondo for your school and association).
Signature of Applicant: _____________________________! Signature of Instructor: _____________________________! Board of Masters Signature: _________________________! ! ! ! ! ! ! ! ! ! ! !
Date: ___________ Date: ___________ Approve: ________ Decline: ________
Order Form
Name: ______________________________! Phone: ________________________ Email: ________________________________
Item
! ! !
Price
$40! $50! $60! ! ! ! ! ! !
Total
$ ___________ $ ___________ $ ___________
Custom Black Belt*!
Special UTA Rank Certicate! Korean Signature Stamp!!
! ! ! ! ! !
! ! ! ! ! !
! ! ! ! ! !
! ! ! ! ! !
! ! ! ! ! !
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Subtotal!
$ ___________ $ ___________ $ ___________
+ Tax (6.5%)! ! ! ! TOTAL! !
Cash, checks, and credit cards accepted. Please make checks payable to the United Taekwondo Association (UTA).
* Please complete and turn in custom belt page with this order form.
Custom Belt Order Form

Please see below for an example of the typical format that we use for a custom black belt. Please note that this is only an example. Your belt can be embroidered in any format that you choose.
Ahn Taekwondo Institute John Doe
(Korean characters)
Name: _______________________________________________________________!
Phone: ________________________ Email: ________________________________
Belt Color: ! !
Poom! !
Black! !
Master Belt (Black with red stripe)
Belt Size: ______________!
Embroidery Color:! !
Gold! !
White! !
Red!
# of Rank Stripes: _______________
First Line of text: ___________________________________________________________
Second Line of text: ________________________________________________________

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Spring of 2012 United Taekwondo Association Black Belt Examination

Saturday, March 17, 2012

David Hamilton Executive Director, United Taekwondo Association

United Taekwondo Association

Desired Grade: __________________ Belt Size: ___________

Test Date: ______/_____/______

Date: ___________ Date: ___________ Approve: ________ Decline: ________

Custom Black Belt*!

Special UTA Rank Certicate! Korean Signature Stamp!!

$ ___________ $ ___________ $ ___________

+ Tax (6.5%)! ! ! ! TOTAL! !

Custom Belt Order Form

Ahn Taekwondo Institute John Doe

Phone: ________________________ Email: ________________________________

Master Belt (Black with red stripe)

Belt Size: ______________!

# of Rank Stripes: _______________

First Line of text: ___________________________________________________________

Second Line of text: ________________________________________________________

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Desired Grade: ________ Belt Size: _

Test Date: ____/_/____

Date: _____ Date: _ Approve: Decline: ____

$ _____ $ _ $ _______

Phone: Email: ________