<p>CONNECTICUT JUDO, INC. RECOMMENDATION FOR PROMOTION</p><p>USJI Membership number (REQUIRED) ______-______</p><p>(1) Name ______(2) Gender M F (3) Date of Birth ______</p><p>(4) Address ______(5) City ______</p><p>(6) State ____ (7) Zip ______(8) Last Rank ______(9) Date of last promotion ______</p><p>(10) Location of promotion ______(11) Promoted by ______</p><p>(12) Club ______A copy of the last certificate must by attached.</p><p>SENIOR  JUNIOR  (13) Recommendation for promotion to ______(14) Date ______</p><p>(15) Recommended by ______(16) Auth.No.______</p><p>(17) Time in Grade ______to ______Years. Months ______</p><p>(18) Points:Competitor  (Copy of record book required.) ______</p><p>Non-Competitor  (Copy of record book required.) ______</p><p>(19) Examinations: General Information and Vocabulary ______</p><p>(20) Practical Evaluation ______needed acquired (21) Examiner’s Recommendation  PASS  FAIL</p><p>(22) Promotional Examination conducted by: (23) Date ______Print name Rank Auth. Number Signature</p><p>1. ______</p><p>2. ______</p><p>3. ______</p><p>4. __ (Rev.05/2003) For official use only: Received by Secretary (date) ______Rank: Granted  Rejected  Certificate made up:______Certificate number ______Certificate sent ______</p><p>Chairman’s signature ______Reason: ______</p>