Portland Center: 2904 SE Belmont St., Portland, OR 97214 / (503) 736-9634
Application for Belt Rank Promotion
Date__________________________
Name______________________________________Age______________
Address______________________________________________________
Telephone_____________________ E-Mail_________________________
Current rank_______________________________ Belt size____________
Name of Instructor______________________________________________
Location of do-jang______________________________________________
Hwa-Rang Foundation scholarship _______Yes
________No
I recommend this student for advancement to the rank of ____ kup.
__________________________
Signature of instructor
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(Do not write below this line)
NOTES FROM INSTRUCTOR:______________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
NOTES FROM PROVOST:________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________