KENYA TAEKWONDO ASSOCIATION

Affiliated to: KNSC, NOCK, AFTU, WT

Headquarters: Kenya National Sports Council offices: Mombasa Road.
P.o B.o.x 61002-00200 Nairobi. Tel: +254-20-352676

KENYA TAEKWONDO ASSOCIATION LEVEL III CERTIFICATE APPLICATION

FORM 증명서 신청 양식

태권도 자격증
PERSONAL INFORMATION
- Full Name:
- Date of Birth:
- Gender:
- Contact Information (address, phone number, email):
- Emergency Contact Details:
- Citizenship/Nationality:
-How Did You Hear About This Program:
TAEKWONDO EXPERIENCE (태권도 경험)
- Current Belt Level:
- Number of Years Practicing Taekwondo:
- Previous Taekwondo Certificates/Accolades:

MEDICAL INFORMATION

- Any Existing Medical Conditions:

- Allergies:
- Medications Taken Regularly:

- Injuries or Physical Limitations:

MOTIVATION AND GOALS

- What are your reasons for Pursuing Level III Taekwondo Certificate (태권도 증명서)

- What are your short-term and Long-term Goals in Taekwondo:

- State How Achieving This Certificate Aligns With your Goals

Headquarters: Kenya National Sports Council offices: Mombasa Road.

Kenya Taekwondo/Grading/Belt Testing @2023-24
REFERENCES
- Name and Contact Information Of Your Taekwondo Instructor or Mentor:

- Brief Recommendation or Endorsement (Optional)

DECLARATION AND CONSENT

- Give a Statement of Authenticity (declaring the provided information is true)
-……………………………………………………….
- Consent for Participation and Agreement to Follow Rules and Regulations
-……………………………………………………….
-What Is Your Taekwondo Membership Status: Active inactive
-If inactive, state your reasons…………………………………………
……………………………………………………………………………………

ADDITIONAL INFORMATION
- Any Additional Skills or Talents Relevant to Taekwondo

- Any Leadership or Teaching Experience in Taekwondo Classes

QUESTIONNAIRE
- Why are you interested in Taekwondo?

Headquarters: Kenya National Sports Council offices: Mombasa Road.

Kenya Taekwondo/Grading/Belt Testing @2023-24
 - What challenges have you faced in your Taekwondo journey, and how did you
overcome them?

- How do you plan to contribute to the Taekwondo community after obtaining the
Level III Certificate?

FOR OFFICIAL USE ONLY

Date:
Student’s Affiliation Membership Number:
Recomender’s Affiliation or Membership Number:
Authorised Signature.

Headquarters: Kenya National Sports Council offices: Mombasa Road.

Kenya Taekwondo/Grading/Belt Testing @2023-24