Black Belt Exam Application Checklist Attend Black Belt Exam Prep Class at KICKS TaeKwonDo. (2) Classes are allowed as an absence but notice must be given to BBE Administrator at least three days in advance.

Order embroidered belt three months prior to Final Exam. Cost is $30.00.

Clean WHITE uniform must be worn for all Pre-Exams and Final Exam. School logo must be on back and all patches properly sewn on.

Must complete and pass all three Pre-Exams before Final Exam. Must sign up for one class per week with Head Instructor and fulfill “Class Leadership Requirement” dependent on belt rank. Must complete Black Belt Run within a 32 minute time period. 3k (approx. 1.9 miles) for children ages 12 and under. 5k (approx. 3.1 miles) for adults ages 13 and up.

Must write essay on how Tae Kwon-Do has affected my life, and what type of leadership role I will perform. Essay must be at least one double spaced page.

Must have (2) wallet sized photos for Final Exam Packet. Must include payment for Final Exam with Final Exam Packet. Must fill out Application Form for Final Exam. Must fill out Final Exam Grade Sheet. Must submit a “letter of recommendation” from a non-family member, at least 18 years old and older. Should include reasonable support as to why I should be promoted to Black Belt.

Must submit all required forms and fees as stated on your Prep Schedule. If any forms are incomplete or illegible, entire package will be returned to me. Must supply my own breaking materials. Must continue training at KICKS TaeKwonDo for at least six months after graduation date. If I fail to display Black Belt traits, my ranking will be withheld.

Signature: _________________________________________________ Date:________________ (Student)

Signature: _________________________________________________ Date:________________ (Guardian if minor)

Black Belt Testing Guide This guide provides information about Black Belt Dan Testing including all requirements. I.

Preparation Classes A. Held every _______________Night 1. 2.

KICKS TaeKwonDo 7:30 PM

B. Mandatory for three months prior to Final Exam C. Absences 1. 2.

Candidates allowed up to (2) absences Must inform BBE Administrator at least three days in advance

D. Embroidered Black Belt 1. 2.

Candidates must place order with BBE Administrator Cost: $30.00

E. Emphasis on knowledge and skills to be tested during Pre-Exams and Final Exam F. Candidates must commit to train at KICKS Tae KwonDo at least six months after graduation. II.


Class Leadership A. Candidates are responsible for at least (1) class in which they assist the Instructor with assigned class B. Varies depending on Belt Rank i.e. Deputy Black Belts are required to complete (26) Class Leadership Classes which are indicated with a red mark on attendance card. Pre-Exams A. Pre-Exam I 1. 2. 3.

All Kicking Combinations Understanding of Level I Sparring (application sparring) Requirement for All Those Testing - One-Step Self-Defense

B. Pre-Exam II 1.

Requirement for All Those Testing - Poomsae (Forms)

C. Pre-Exam III 1.



Requirement for Those Testing for 1st Dan - Written Exam, questions will be posted at each location (Must score a minimum of 70%) - Demo of Speed, Power & Jump Breaking Techniques Requirement for Those Testing for 2nd Dan - Creative Forms (see Head Instructor for guidelines for duration) - Weapons (see Head Instructor for guidelines for duration) - Knife Self-Defense (minimum (6) techniques) Requirement for Those Testing for 3rd Dan and Above - Creative Forms (see Head Instructor for guidelines for duration) - Weapons (see Head Instructor for guidelines for duration) - Creative Self-Defense (minimum (6) techniques, must be different from Knife Self-Defense) - Creative Knife Self-Defense (minimum (6) techniques)

D. Pre-Exam Application 1. 2.

Make at least two additional copies so that you have one for the second and third PreExams, only one is supplied in this packet Must be turned into BBE Administrator one week prior to specified Pre-Exam


Black Belt Dan Packet A. Must be submitted along with payment no later than the date stated on your Prep Schedule. -

Incomplete, incorrect, or illegible application materials are unacceptable and will be returned to candidate

B. Order of Packet Materials 1.

Two Wallet-Size Photos - Helps Examiners Identify Candidate at Final Exam Sample Picture Size used with Dan Application: 2 photos this size or smaller.

2x2 2.

3. 4. 5.




Exam Fee (Check, Cash or VISA/Mastercard) - Varies dependent on belt level, please see Black Belt Dan Application Sheet Black Belt Dan Application - Must be filled out Completely Final Exam Grade Sheet - Fill out top portion only Letter of Recommendation from a non-family member - Must be written by someone 18 years of age and above - Please have them specify why they feel that you should be testing for your Black Belt Black Belt Exam Application Check List - This is the first page of this packet - Helps as a final check of all materials prior to Final Exam Essay - This packet includes detailed guidelines for Essay - Must submit (2) copies with the title page signed - Must be at least one page, double-spaced, 12 point font - Quality of writing must be consistent with the age of the student

Road Test A. Those 12 years and under 1. 2.

3k Run (Approximately 1.9 miles) is mandatory Time Limit: 32 minutes

B. Those 13 years and up 1. 2. 3.

5k Run (Approximately 3.1 miles) is mandatory Time Limit: 32 minutes 4th Dan Candidates are required to complete a 10K Run

C. Exceptions 1. 2.

Doctors Note for Medical Health Reason Doctors Note for Injury

D. Other Notes 1. 2.

If you do not make it under the time limit the first time you do the run, you will have a make-up run scheduled to retest. Please start training for your run accordingly so that you will have ample time to be conditioned prior to the Scheduled Running Date.


Final Black Belt Exam Breaking Materials 1.

2. 3.


Each Candidate must perform three different sets of breaks. - Speed: a break that relies on speed to be successful - Jump: a break that incorporates jumping, i.e. you are off the ground when you perform the break - Power: a break that demonstrates power and technique Each Candidate must supply their own breaking materials, boards and cinderblocks - These materials can be purchased through KICKS TaeKwonDo. Cinderblocks are not mandatory for power technique - Dimensions: 1 (5/8) inch thick X 14 inch long cap blocks - Candidates can purchase the scalloped cinderblocks if the above is not available. Board Dimensions (see diagram below) Grain of Board

Ages 12 and Under Minimum of 4 inches wide Ages 13 and Up Minimum of 6 inches wide

1 inch thick 12 inches in length

***Note: Demo Boards are not permitted for Black Belt Final Exam.


Graduation A. Will take place after Final Exam B. Dates will be posted later C. Candidates will receive belt, certificate and new uniform during Graduation

VIII. Reminder Notes A. Candidates must wear clean white uniforms with the school logo on the back, and Korean and American Flags on the sleeves. (This is mandatory especially during Pre-Exams and Final Exams) B. Candidates must attend two regular classes other than the Black Belt Preparation Class guided by KICKS TaeKwonDo Master Instructors. Please note that KICKS TaeKwonDo does not promote the candidates who are lacking in testing preparation.

Black Belt Guidelines for Graduating With Honors 1. Preparation Classes/Attendance -Candidates must have 100% Perfect Attendance at Black Belt Prep Classes 2. Belt Orders - Belts must be ordered and paid for on date specified by Black Belt Exam Administrator 3. Written Exam -Candidates must score at least an 88 or higher (B Average) 4. Pre-Exams -Candidates must pass all three Pre-Exams on their first attempt 5. Final Exam -Candidates must have an overall score of at least a B Average 6. Road Test -Candidates must fulfill 32 minute requirement without retaking the road test. 7. Leadership Classes -Candidates must complete all Leadership Classes according to their rank -1st Dan Candidates (currently Deputy): 26 Leadership Classes -2nd Dan Candidates (currently 1st Dan) & Up: 52 Leadership Classes 8. Black Belt Dan Packet -Exam Packets must be turned in either to the Black Belt Exam Administrator by the date assigned -Packets must include all of the following: Two Wallet-Size Photos Exam Fee Black Belt Dan Application Final Exam Grade Sheet Letter of Recommendation from a non-family member Black Belt Exam Application Check List Essay

9. Honorable Demeanor - Candidate must show traits that are honorable as a Black Belt. Technique alone does not merit a Black Belt. We are looking for dedicated individuals who can lead as fine examples for their junior belts. 10. Total Preparedness - Candidate must be punctual to all practices and ready to perform for all Pre-Exams. i.e. Proper Uniform, Safety Gear, etc. In order to receive the distinction of “Graduating with Honors,” Candidates must fulfill (9) out of the (10) requirements listed above to be considered as a candidate. Distinction is awarded to the top 5% of the Graduating Class.

Pre-Exam Application (Type or write in print) Name:______________________________Current Rank:____________________Age:_____ Address:____________________________________________________________________ Pre-Exam: (Circle One)




I submit this application to the promotion board of KICKS TaeKwonDo for a Black Belt PreExam. Signature:____________________________________________Date:__________________ (Student) Signature:____________________________________________Date:__________________ (Guardian if minor) *** I understand that I must order the embroidered belt three months before the final exam date and have paid $30 for the belt. If you’ve already placed an order, please check here____. Do not write below this line Pre-Exam I: One-step self-defense, kicking combinations, sparring curriculum applicability (Level 1) Pre-Exam II: Forms Pre-Exam III: For 1st Dan: Written exam (must score a minimum of 70%), Breaking Technique For 2nd Dan: Creative Forms, weapons, and Knife Self-Defense For 3rd Dan & Above: Forms, weapons, Knife Self-Defense & Creative Self-Defense

Examiner’s Section:

Examiner’s Signature:__________________________________Pass:_________Fail:________

Black Belt Dan Application Name (As it should appear on certificate):____________________________________________ Current Rank:______________________Applying For:__________Dan Date of Birth:_______/_______/______


Belt Size:__________


Address:__________________________________________Zip:_________ Country:________ E-mail:____________________________

Ph 1:__________________ Ph 2:_______________

Emergency:____________________________________________________________________ Country:__________________________________Head Instructor:_______________________ Fees:

1st Dan $350 5th Dan $750

2nd Dan $450 6th Dan $850

3rd Dan $550 7th Dan $950

4th Dan $650

*KICKS TaeKwonDo will present a new Dan ranking uniform at graduation. *To apply for a Kukkiwon Certificate from Korea, separate fee is required. (Optional) Final Exam Contents Mandatory For All Candidates: Forms, Self-Defense, Breaking Technique: Speed, Jump & Power, Essay, Road Test Check Box Below For Dan Applying For:

□ □ □ □

Dan Applying For 1st 2nd 3rd 4th

Additional Final Exam Requirements Sparring 1 vs. 2 Creative Forms, Weapon, Knife Self-Defense, Sparring 1 vs. 3 Creative Forms, Weapon, Knife Self-Defense, Creative Self-Defense, Sparring 1 vs. 4 Creative Forms, Weapon, Knife Self-Defense, Creative Self-Defense, Sparring 1 vs. 5

Please check, include all the items below when submitting this form. I have included the non-refundable fee in cash or money order form in an envelope. I have included two wallet size photos. I have included two copies of essay, typed double spaced, minimum of one page with a cover page. The essay must be signed by me & the cover page must have the title, my name, final exam date, and the Dan I am applying for. I have included a “letter of recommendation” from a non family member, supporting why I should be promoted to Black Belt and why they feel that way. I submit this application to the promotion board of KICKS TaeKwonDo for a Black Belt Final Exam to be held (date):___________________________ Signature:____________________________________________Date:__________________ (Student) Signature:____________________________________________Date:__________________ (Guardian if minor)

Exam Grade Sheet Name:______________________________Applying Dan:________Age:_____Gender:_______ Ranks















Fields Forms One Steps Footwork Combos Sparring

Curriculum Applicability (80%)

Peformance (20%)






Weapons Knife & Creative Defense Written Leadership


Class Leadership

Creative Form

Music: Yes or No

Road Test



Essay Comments



Fail:________ Other:________ Dan # if pass:______

Examiner’s Signature:___________________________________Date:____________________

Essay Guidelines This is your opportunity to tell us something about you, your life, or your goals that are not obvious from your practice of Tae Kwon Do. It is also an opportunity to express appreciation to those who have helped you along the way.

1) Must be at least one page, double-spaced, 12 point font. (Title page must include candidates name, rank applying for and Final Exam Date)

2) Two copies must be submitted with title page signed. 3) Must be written at an age appropriate level.

Treat this essay as you would a piece of writing for school or your business. If you are in High School, we do not expect a grade 3 level essay. Topics that are often included are:

• Why I started Tae Kwon Do • How it has improved my life physically and mentally • Who I used as a mentor in my efforts • Interesting anecdotes • Advice you might give to other students aspiring to achieve Black Belt level • Thanks to people who have helped you along the way • A Lesson you took away from your Tae Kwon Do journey that you would like to share with others. These are just guidelines and may not necessarily be included in your essay. Your essay should reflect how YOU feel at YOUR Black Belt Test.

KICKING COMBINATIONS White (No Kicking Combo, Only Footwork)

H. White (Footwork & 1 Kicking Combo)

Yellow High Yellow Green High Green Blue High Blue Red High Red Deputy Black

Single Switch Double Switch Step Forward Step Back Shuffle Forward Shuffle Back Middle Roundhouse Kick, Drop Kick, Step Forward and Punch Cut Step, One Step Forward, Turning Back Kick Fast Step Roundhouse, Turning Back Kick, Roundhouse Kick Cut Step, Turning Whip Kick Fast Step Roundhouse, Single Switch, Turning Whip Kick Fast Step Roundhouse, Tornado Roundhouse Kick Turning Whip Kick, Standing Switch, Turning Whip Kick One Step Forward, Jumping Turning Back Kick Shuffle Back, Double Roundhouse Kick Fast Step Roundhouse Kick, Roundhouse Kick, Tornado Roundhouse Kick

1 Dan

Side Step, Roundhouse Kick Step Forward, Side Step, Roundhouse Kick

2 Dan

Fast Step Roundhouse Kick, Double Roundhouse Kick, Switch, Turn Back Kick