Form

Martial Arts Commission

New Commissioner Application
Date of Submission
- Month - Day Year
at
/ Hour Minutes
GENERAL INFORMATION
Full Name*
First Name Last Name
Gender (M or F)*
Birth Date*
Month Day Year

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Best Phone*
- Area Code Phone Number
Occupation (Choose as many as apply)*

Full Time Martial Arts Instructor Part Time Martial Arts instructor Military Service Marketing/Sales Law Medicine Finance Business Management Consulting Education Clerical Production Self-Employed Now Retired Volunteer Other
Job Title*
Name of Martial Art School or NA*
Number of Martial Art Students in my school?*
Current Instructor's / Mentor's Full Name (or John Doe)*
First Name Last Name
Current Instructor's Dan Rank*
At this School, I am ... (Check all that apply)*

The Business Owner The Headmaster An Instructor with a Scheduled Class(s) An Assistant Instructor A Student An Adult with Talent & Skills to Offer

School/OfficeAddress*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

School/Office Phone Number or 000-000-0000*
- Area Code Phone Number
FAX Number or 000-000-0000*
- Area Code Phone Number
Best Phone or 000-000-0000*
- Area Code Phone Number
Best E-mail*
I look at my email*
Website URL of NA*
Dan Rank History
Date Began TKD/MA Training OR JANUARY 1, 1920)*
Month Day Year
Date Achieved 1st Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 2nd Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 3rd Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 4th Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 5th Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 6th Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 7th Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 8th Dan (or JANUARY 1, 1920)*
Month Day Year
Date Achieved 9th Dan (or JANUARY 1, 1920)*
Month Day Year
KUKKIWON CERTIFICATION
Your Present Kukkiwon Rank (or NA)*
Dan Certificate # (or 0000)*
Kukkiwon Certification Date (or JANUARY 1, 1920)*
Month Day Year
USAT-MAC DAN RANK CERTIFICATION
USAT-MAC Taekwondo Rank (or NA)*
USAT-MAC Certificate # (or 0000)*
USAT-MAC Certification Date (or JANUARY 1, 1920)*
Month Day Year
OTHER DAN RANK CERTIFICATION
Your Rank from other Organization (or NA)*
Other Organization Certificate # (or 0000)*
Other Organization Certificate Date (or JANUARY 1, 1920)*
Month Day Year
Name of Organization Issuing Your Certification (or NA)*
RESUME
I would like to become a Commissioner*

Yes No
I am recommended by the this/these Commissioner(s)*
By Experience and/or Education I am best qualified to serve the Martial Arts Commission by participating in the following Councils:
Council of 1st Choice*
Council of 2nd Choice*
Council of 3rd Choice*
Council of 4th Choice*
Names of Organizations you currently belong to (other than USAT)*
Martial Arts Achievements / Experiences*
Education and Achievement other than Taekwondo - Martial Arts (Highest Level of Education)*
Community (Experiences / Services / Achievement)*
Your plans and thoughts regarding the position(s) in which you would like to serve.*
USAT MEMBERSHIP STATUS
My USAT Membership Status*
I have been a USAT (formerly USTU) Member since*
USAT Membership # or NA*
I will register for USAT Membership*

I am a Current Member Yes No
I am the owner of a currently registered USAT Club*

Yes No
Club Number or NA*
Number of Registered USAT Members in my school?
I have had a registered USAT (formerly USTU) Club since ...*
Upload your Personal Photo, Certificates and Resume (Martial Art Activities; Other Career; Community Service) These documents will be required to complete your application. If you cannot upload them now, please prepare to mail them as soon as possible.
Upload your Portrait Photo*
Upload a copy of your Highest Rank Certificate (Org #1)
Upload a copy of your Highest Rank Certificate (Org #2)
Upload a copy of your Highest Rank Certificate (Org #3
Upload your Resume
Would you like to recommend someone to be a Commissioner?
Recommended Person's Full Name
First Name Last Name

Recommended Person's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Recommended Person's Dan Rank if applicable
Rank/Profession
Phone Number
- Area Code Phone Number
E-mail
Web (URL)
I am recommending this person because:
Enter the letters as shown. (If you make an error, another display will be shown)*
Should be Empty:

Upload your Personal Photo, Certificates and Resume (Martial Art Activities; Other Career; Community Service) These documents will be required to complete your application. If you cannot upload them now, please prepare to mail them as soon as possible.

Would you like to recommend someone to be a Commissioner?