APPLICATION FOR PROMOTION IN KODOKAN DAN GRADE

Family Name First Name Middle Name

□Mr.
□Ms.
1.Name

Kana

Signature

□Contest points

□Non-Competition results (NCR)

2.Dan Recommended Recommended by
Dan □Merit

□Examination

3.Address

(E-mail: )

Day Month (Jan-Dec) Year

4.Date of Birth

5.Nationality 6.Occupation

Day Month Year

7.Date of enrollment
in Kodokan

8.Present Dan Day Month Year

Date
by Kodokan 　　　 　Dan

Day Month Year

9.Present Dan/Kyu
Date
in Your Country □Dan/□Kyu

10.Present daily Training Sensei

 training Club/Dojo (Dan)

Training judo
hours / times / □week/□month

11.Favorite
Technique

12.Kata,
studied

13.Personal Year to start Judo Club/Dojo to start Judo Sensei (Dan)

History

of Judo
Others
Activities

Name of Opponent’s Result

14.Contest Date
Tournament Name and Dan/Kyu (Win/Draw)
Records
Sample Sample Sample Sample

2010/Aug National Judo Championships Mr. Taro YAMADA WIN

15.Merit for (If you are recommended by NCR, you must fill this part.)

the diffusion

and development

of Judo

16.Comment for

Recommendation

Submitted by

Date :