United States Soo Bahk Do FOR H.Q. USE: SOO Gi SCORE JOK GI SCORE HYUNG SCORE OTHER SCORE T.A.C. APP.______Moo Duk Federation Inc.â Low Block / / Front Basic Form #1 3-Step Spar FEE PD.______Tuel Oh RECORDED______High Block / APPLICATION / Round Kick Basic Form #2 1-Step Spar ID & CERT______Tuel Oh FOR GUP PROMOTION In/Out Block Side Kick Basic Form #3 Self-Defense Student Portion Testing Date Studio Certification No Out/In Block In / Out Kick Pyong Ahn #1 Free Spar

Center / / Out / In Kick Chil Sung #2 Breaking Gup Membership No. Expiration Date Tuel Oh

High Punch / Name of Studio / Back Kick Pyong Ahn #3 CONTROL SCORE Tuel Oh

Jump Front Name Male Female Side Punch Chil Sung #1 Eye Focus Kick Last First Init. Address Side Block Spin Side Kick Pyong Ahn #5 Balance Control Street City State Zip Knife Hand Block Spin In / Out / Breathing Control Date of Birth Telephone Low / Middle Kick High Knife Hand Tension & Jump Side Kick Chil Sung #3 Occupation Education Level Block Relaxation Back Fist / Speed & Power / Hook Kick Date of entrance Date of last promotion Present Rank Gup Hammer Fist Control Soo Do / Jump Round / Timing Control Applicant’s Signature ______Tuel Oh Kick 2 Fist Block Low / Average Score / Spin Hook Kick Parent’s Signature (if under 18) ______Middle for Control Jump In / Out Instructor Portion 2 Fist High Block / Kick Spear Hand/Tuel Jump Out / In / Recommended by Rank Dan No. Oh Kick An average score of 9.0 or above: 2 level promotion Reverse Round *EXAMINERS NOTES: Ridge Hand POINT SYSTEM: An average score of 7.0 or above: 1 level promotion / Kick / Front / Strike/ Tuel Oh An average score of 7.0 or below: Fail Push Kick Jump Spin *AVERAGE SCORE is determined from taking an overall average of: Spinning Back Fist / Back Kick / In / / 1) Average score from Soo Gi 3) Average score from control / Hammer Fist 2) Average score from Jok Gi 4) Each score from each Hyung Out Kick 5) Each score from 3-step spar, Free Spar, Self Defense, Breaking and Terminology Yuk Jin Kong Jump Spin

Kyuk Hook Kick Mail all correspondence to: Technical Advisory Committee Average Score Average Score

U.S. Soo Bahk Do Federation Inc.â for Soo Gi for Jok Gi P.O. Box 154 Springfield, N.J. 07081 Combinations Orange (1-7) I recommend promotion of this student to Gup. Average Score Green (8 – 14)

Red (15 – 20) FOR STUDIO USE Signature(s) of Examiner(s) and ID# Class attendance _____ 1. Free Motion Class in general______Average Score 2. Retest status: 3. for Combinations 4. ã 2003 United States Soo Bahk Do Moo Duk Kwan Federation Inc. 5.