Promotional Forms - USJF Form 20 - United States Judo Federation

UNITED STATES JUDO FEDERATIONRECOMMENDATION FOR PROMOTIONNAME (Mr. Mrs. Ms. Miss Dr.)ADDRESSCLASSIFICATION COMPETITOR NON-COMPETITORLAST FIRST MIDDLE( 2 ) PROMOTION HISTORYCITY ST & ZIP Copy of last rank certificate isPHEMAILREQUIRED if NON-USJF rankAGE DOB HEIGHT WEIGHT RANK DATE USJF Rank # OtherOCCUPATION FIRM 8 DAN( 3 ) JUDO AFFILIATIONS 7 DANAFFILIATION BEGINNING PRESENT 6 DANDOJOYUDANSHAKAIINSTRUCTORENTRY DATE5 DAN4 DAN3 DAN2 DAN( 4 ) SHIAI RECORD 1 DANDATE EVENT OPPONENT RANK RESULT IKKYUENTRY( 5 ) KATA PROFICIENCYMUST have ALL required kata(s)Please input certification level or “√”NAGE:KATAME:KIME:JU:GOSHINJUTSU:ITSUTSU:KOSHIKI:( 6 ) GENERAL ABILITYAVE WEEKLY PRACTICE:( 7 ) AWARDS-CHAMPIONSHIPS-CONTRIBUTIONS FAVORITE WAZA:DATE DESCRIPTION ORGANIZATION/EVENTSGENERAL ATTITUDE:( 8 ) EDUCATIONAL HISTORYEDUCATION GRADE SCHOOL HIGH SCHOOL COLLEGE GRADUATE DegreesYEARS COMPLETED 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 1 2 3 4 5( 9 ) YUDANSHAKAI ENDORSEMENTDATE:RANK RECOMMENDED:REASON FOR RECOMMENDATION:YUDANSHAKAI:SIGNED:TITLE:ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 1 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________1. USJF Charter Club Head Instructors – Must be Head Instructor the entire Time in Grade period(Reduction % = 50 members & more – 10%; 30-49 – 7%; 20-29 – 5%; 10-19 – 3%; 1-9 – 1%)Year Club # of MembersPart 1 maximum TIG reduction = 10% & cannot claim TIG under Part 2Total Reduction %: _______________2. USJF Charter Club Assistant Instructors – Must be Assistant Instructor the entire Time in Gradeperiod (Reduction % = 50 members & more – 5%; 30-49 – 4%; 20-29 – 2%; 10-19 – 1%)Year Club # of MembersPart 2 maximum TIG reduction = 5%Total Reduction %: ________________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 2 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________3. Referee and Technical StaffReferee Class: ________________Technical Staff Level: ________________Work an average of 6 or more events per year during entire Time in Grade Period:Referee Class – A/B/C/N 6% Technical Staff – Natl/Intl Events 6%Referee Class – Regional/Local 4% Technical Staff – Regional/Local 4%Work an average of 3 to 5 events per year during entire Time in Grade Period:Referee Class – A/B/C/N 3% Technical Staff – Natl/Intl Events 3%Referee Class – Regional/Local 2% Technical Staff – Regional/Local 2%Year Event Event Event Event Event EventPart 3 maximum TIG reduction = 6% via any combination of activitiesTotal Reduction %: ___________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 3 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________4. Kata Judge and Kata Technical StaffWork an average of 2 or more events per year during entire Time in Grade Period:Judge Class – A 6% Technical Staff – Natl/Intl Events 6%Judge Class – Regional/Local 4% Technical Staff – Regional/Local 4%Kata Judge Certification Level:Nage ___ Katame ___ Ju ___ Kime ___ Goshinjutsu ___ Itsutsu ___ Koshiki ___Technical Staff: __________________________________________________________Year Event Event Event Event Event EventPart 4 maximum TIG reduction = 6% via any combination of activitiesTotal Reduction %: ___________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 4 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________5. Kata Instructor CertificationKataNage no KataKatame no KataJu no KataKime no KataKDK GoshinjutsuItsutsu no KataClass A(1%) / DateClass B(.5%) / DateKoshiki no KataPart 5 maximum TIG reduction = 7% (1% per kata)Class C(.25%) / DateCheckedReduction%Total Reduction %: ____________6. Coach Certification(National Gold – 5%; National Silver – 3%; National Bronze – 2%; National Coach - 1%)CertificationCoachNational GoldDateNational SilverDatePart 6 maximum TIG reduction = 5%National BronzeDateNational CoachDateReduction%Total Reduction %: __________7. Teacher Certification (Master Teacher – 5%; Instructor – 3%; Assistant Instructor – 1%)CategoryMaster TeacherDateTeacherPart 7 maximum TIG reduction = 5%InstructorDateAssistant InstructorDateReduction%Total Reduction %: __________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 5 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________8. USJF Life Member (LM) & Presidentʼs Club Life Member (PCLM) (5% to 10%)Category Membership # Date Reduction %Regular LM - 5%PCLM Charter - 6%PCLM Executive - 7%PCLM Presidential - 8%PCLM Executive VIP - 9%PCLM Presidential VIP - 10%Part 8 maximum TIG reduction = 10%9. Service as Yudanshakai Officer (10%)From To PositionTotal Reduction %: ____________Part 9 maximum TIG reduction = 10%Total Reduction %: ____________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 6 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________10. Service as USJF Officer (10%)From To PositionPart 10 maximum TIG reduction = 10%Total Reduction %: ____________ALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 7 of 8 USJF Form 20, v4.3.1, 120531

REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONMax. Reduct. of Time-In-Grade for Non-Competitors Is 30% For All 10 Sections (Total) - 10/18/00 & 4/19/12Max. Reduct. of TIG for Comps. is 5%-10% for Life & Presidentʼs Club LM, Depending on LM Type - 9/23/09 & 4/19/12Note: Please Attach To Page 1 Of The Form 20 Only Those Pages, If Any, With TIG Reduction EntriesCandidate Name: ______________________________________________SUMMARY OF REDUCTIONS OF TIME-IN-GRADE BY CONTRIBUTIONCategory Reduction % Maximum1. USJF Charter Club Head InstructorsMust be teaching entire Time in Grade period10%2. USJF Charter Club Assistant InstructorsMust be teaching entire Time in Grade period3. Referee and Technical Staff 6%4. Kata Judge and Kata Technical Staff 6%5. Kata Instructor Certification 7%6. Coach Certification 5%7. Teacher Certification 5%8. USJF Life Member 10%9. Service as Yudanshakai Officer 10%10. Service as USJF Officer 10%Cumulative TIG Reduction For Non-Competitors Cannot Exceed 30% - 10/18/00 & 4/19/12Maximum TIG Reduction For Competitors Is 5%-10% For Life & Presidentʼs Club Life Membership,Depending On Life Membership Type - 9/29/09 & 4/19/12Total Reduction %: ________________5%Promotion Candidate Endorsement:Promotion Candidateʼs Name Signature of Candidate DateYudanshakai Endorsement: Yudanshakai Official – President/Chairman of Board of ExaminersYudanshakai Officialʼs Name & Title Signature of Official DateALL pages MUST be typed for submission to the National Office • Altered forms will be rejectedPage 8 of 8 USJF Form 20, v4.3.1, 120531