Grading Syllabus Forms EN 2010 by d2BW30q

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									                                                                                                                                           NGBe-1

                                           RECOMMENDATION FOR DAN PROMOTION
                          212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299


                                              PLEASE PRINT IN BLOCK LETTERS


Candidate for               Dan
                                                                                     Provincial No.                          Judo Canada No.



Surname                              First Name                                              Dojo                            Date of Enrollment



Address                                                                                 Instructor - Dan                     Year started Judo



City                          P/T                 Postal Code                                       Previous Instructor(s)


                                                                                                    Previous Instructor(s)
Telephone no. (h)                    Telephone no. (w)                                         Certifications - Date Obtained
                                                                             Rank                   Referee                   NCCP
                                                                             1K                     Prv C                     I / DA
E-mail                                                                       1D                     Prv B                     II / DI
                                                                             2D                     Prv A                      III
Sex          F      Citizenship      Canadian                                3D                     Nat C                      IV
             M                       Permanent Resident                      4D                     Nat B                       V
                                     Other                                   5D                     Nat A                     Course Facilitator
                                                                             6D                       Reg                     I / DA
Age                        Date of birth                                     7D                       PJU                     II / DI
                                             DD      MM        YYYY          8D                        IJF                     III
                                                                                                                               IV

EVALUATION          E - Excellent             VG - Very Good                 G - Good                  F - Fair               R - Repeat



                                                                             Tori                                    Uke
       Nage-Waza                                            Nage-no-kata
       Osae-Waza                                       Katame-no-kata
   Shime-Waza                                                  Ju-no-kata
Kansetsu-Waza                                                 Goshin-jitsu
         Randori                                            Kime-no-kata
 Renraku-Waza                                              Itsutsu-no-kata
  Kaeshi-Waza                                           Koshiki-no-kata
           Ukemi                                       Remarks / Remarques



APPROVED                                                                     Method of Evaluation
                                                                                                                                        Pass
                                                                             Examination                                                Repeat
Chairman, Provincial Grading Board                  Date                                                   dd   mm    yyyy
                                                                             Batsugun                                File enclosed


                                                                             Special Case                            Letter of recommendation
Chairman, National Grading Board                    Date
                                                                             Other


                ALL FORMS MUST BE CORRECTLY COMPLETED WITHOUT ERRORS OR OMMISIONS
  NGBe-1
                                                                                                                                                       NGBe-2

                                                                          POINT SUMMARY
                                       212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299



                                                                                 Surname                                                          First Name


                                 Current Rank                  Dan               Age                               Time in Grade
                                                                                                                                    years              months



                                19       19      19       19         19     19   20        20       20       20        20      20         20      20       Total

Active in Judo            NT

Kata Tournaments

Kata Participation

Shiai Tournaments

Shiai Partiicpation

Head Sensei

Assistant Coach

NCCP Certification

Coaching

Clinic Conductor

Clinic Participant

Kata Certification

Kata Evaluating

Referee Certification

Refereeing

Administration            NT

Tournament Volunteer      NT


                 Total Annuel



                                     Total Technical / Competitive Points                                                   Grand Total



                        APPLICANTS MAY BE ASKED TO PROVIDE ADDITIONAL DOCUMENTATION TO VERIFY POINT TOTALS


                                                                          DECLARATIONS


    I hereby certify that all information above is accurate and true                   I hereby certify that all information above is accurate and true




    Signature of Candidate                                     Date                    Signature of Chief Instructor                           Date
CANDIDATES SHOULD RETAIN A PHOTOCOPY OF THESE FORMS (NGBe 1, 2, 3A & 3B) FOR THEIR RECORDS
                                                                                                                                                     NGBe-3A

                                                                 SHIAI AND KATA POINTS RECORD
                                             212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299


                                                                                                                      Current Rank                   Dan
                                Surname                                                           First Name
                                                          POINT SYSTEM (STARTING AT U17 COMPETITIONS)


SHIAI      IP-10     WA-7              Yuko or less - 5               PARTICIPATION - 5 points


KATA       8 points* for placing 1st                                   PARTICIPATION - 5 points
           6 points* for placing 2nd
           4 points* for placing 3rd
           2 points* for placing 4th
           2 points* for placing 5th                                      * a minimum of 5 teams entered the event

   DATE                     EVENT AND LOCATION                          OPPONENT/PARTNER              RANK        KATA          RESULTS   PARTICIP    POINTS
dd mm yy                                                                       (uke/tori)                      Kata   # Pairs             POINTS




                                                                  TRANSFER TOTALS TO NGBe-2
                                                                                                                                              NGBe-3B

                                          NON-COMPETITIVE POINTS RECORD
                         212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299


                                                                                             Current Rank                               Dan
                  Surname                                               First Name


                  TECHNICAL                                      Code                                                                   Max/yr
                  NCCP Certification                               T1   DA - 10 DI - 10 III - 20 IV- 20     V - 20
                  Coaching (NCCP Certified)                        T2   DA - 5 DI - 15 III - 15 IV- 15      V - 15                       30
                                                                         Club     Reg      Prov   InterPv    Nat     Cont.     Int'l
                  Clinic Conductor                                 T3                       10               15                20        30
                  Clinic Participant                               T4                       5                 5                          20
                  Kata Certification                                                        5                10       15     20/25/30
                  Kata Activity                                                             5                10                15        30
                  Referee Certification                            T5                       5                10              20/30/40
                  Refereeing                                       T6                       5                                            25
                  Refereeing                                       T6                               10                                   20
                  Refereeing                                       T6                                        15                20
                  Refereeing Maximum points total                  T6                                                                    60
                  NON-TECHNICAL                                          Club     Reg      Prov   InterPv    Nat               Int'l
                  Active in Judo                                   N1     as 1kyu - 30      as 1D - 25        as 2D+ 20
                  Administration                                   N1                       10               15                20        20
                  Volunteer at Tournaments                         N2                       3       4         5                 5        10


CODE    DATE                 EVENT                       LOCATION                        POSITION                     LEVEL               POINTS
       dd mm yy                                                                                                                         Tech
TRANSFER TOTALS TO NGBe-2
NGBe-3B




POINTS
   Non-T
                                        RECOGNITION REQUEST FOR BLACK BELT RANK
                                          OBTAINED FROM A FOREIGN FEDERATION
                              212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299



                                                  PLEASE PRINT IN BLOCK LETTERS



              Surname                             First Name                         Provincial No.                      Judo Canada No.



                                Address                                                  Present Dojo                    Date of Enrollment



          City                    P/T                Postal Code                     Instructor - Dan                    Year started Judo



Telephone no. (h)                         Telephone no. (w)                            Present Rank                        Date Obtained



E-mail                                                                                Granting Federation (no abbreviations please)
                                                       Sex         F
                                                                   M       Granted as:           Batsugun                 Non-Competitor
Citizenship                                                                                      Koseki                   Honorary
                                Date of birth                                                    Competitor
Status        Citizen                           DD      MM     YYYY
              Permanent Resident
              Work Permit                                                  Attached Documents                 Judo Canada Passport
              Foreign Student                           Age                                                   Proof of previous Dan rank(s)
              Political Refugee                                                                               Proof of immigration status
              Other                                                                                           Payment



Signatures



Signature of Candidate                                                        Date



Signature of Head Sensei                                                      Date



Signature of Provincial Grading Board Chairman                                Date


               ALL FORMS MUST BE CORRECTLY COMPLETED WITHOUT ERRORS OR OMMISIONS


Reserved for Judo Canada use.


    Accepted
                            Comments


    Refused
                            Reason for Refusing



                            Signature of National Grading Board Chairman                                  Date
                                           GRADING PAYMENT SCHEDULE
                      212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299



                                                                                 Examination Date:


A complete application includes:

   member                      Judo Canada Passport                  complete NGBe forms                payment in advance




   BC       AB         SK          MB          ON         QC         NB          NS         PE          NL              YK




Judo Canada Grading Fees                                         Kodokan Fees
                                                                 Fees are subject to change without notice.
Shodan                                  x 250 $

Nidan                                   x 200 $                  Membership                                  x 125 $

Sandan                                  x 175 $                  Shodan                                      x 100 $

Yondan                                  x 150 $                  Nidan                                       x 125 $

Godan                                   x 125 $                  Sandan                                      x 150 $

Rokudan                                 x 125 $                  Yondan                                      x 220 $

Shichidan                               x 100 $                  Godan                                       x 325 $

Hachidan                                x 100 $                  Rokudan                                     x 575 $

Kudan                                   x 100 $                  Shichidan                                   x 700 $

Foreign Rank Recognition                x 55   $                 Hachidan                                    x 950 $

Honorary                                x 25   $                 Replacement Diploma                         x 35       $

Replacement Diploma                     x 25   $

                                   Total       $                                                        Total           $

Payable to Judo Canada                                           Reserved for Judo Canada

Judo Canada Membership Fees                    $                 Verification of membership                         /        /
                                                                 Documents sent to Chairman                         /        /
Judo Canada Grading Fees                       $                 Documents received from Chairman                   /        /
                                                                 Judo Canada Passport Returned                      /        /
Kodokan Membership & Grading Fees              $                 Certificates sent to Chairmen                      /        /
                                                                 Certificates sent to President                     /        /
                                   Total       $                 Certificate sent to Province                       /        /
                                         GRADING EXAMINATION FORM
                     212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299


                                                                                Examination Date:

      BC        AB         SK        MB          ON         QC          NB         NS           PE     NL   YK


   Candidates for                 Dan                               Number of Candidates


      Name of Candidates                                                Initials of Examiners




Name and Grade of Examiners

                                                 Dan                                                        Dan

                                                 Dan                                                        Dan

                                                 Dan                                                        Dan

                                                 Dan                                                        Dan


                                              Dan
Signature of Provincial Grading Board Chairman                   Date
                                NATIONAL COACHING CERTIFICATION PROGRAM
                           PROGRAMME NATIONAL DE CERTIFICATION DES ENTRAINEURS
                            212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299



              PLEASE PRINT IN BLOCK LETTERS / S.V.P. ÉCRIRE EN CARACTÈRES D'IMPRIMERIE




                   Last Name / Nom de Famille                                                       First Name / Prénom



                                                                Address / Adresse



                             City / Ville                                           Prov.                      Postal Code / Code Postal



                          E-mail / Courriel                                                  Telephone # (h) / No. téléphone (d)



                      Fax # / No. télécopieur                                                Telephone # (w) / No. téléphone (t)


        Male / Homme                          Female / Femme                Birthdate / Date de Naissance
                                                                                                                          DD       MJ     YYAA




     No. Judo Canada No.                       Rank / Grade                No. Provincial No.                           NCCP No. PNCE




                                                  Dojo                                                                   Years in Judo
                                                                                                                        Années de Judo


                          Sensei                                            Dan




Candidate for Level                Technical Course                         Candidat pour Niveau                        cours technique


                                                                                                                Date:
                             Location of course / Emplacement du cours                                                    DD       MJ     YYAA


Theory Course completed? / Cours de théorie complété?               Yes / Oui         No / Non


Enclosed is the course registration fee of                                                            Cheque / Chèque
Ci-joint est le frais d'enregistrement au montant de                              by / par
                                                                                                      Money Order / Mandat poste




                                                    Signature                                                             DD       MJ     YYAA
                                                          PASSPORT APPLICATION
                                                          DEMANDE DE PASSEPORT
                                212-1725 St. Laurent Blvd. Ottawa, ON K1G 3V4 t: 1-877-738-JUDO f: 613-738-1299


            New Application                             Replacement Passport
            Nouvelle Demande                            Remplacement d'un Passeport                    JC Member Number / Numéro de membre JC

                                                     PLEASE ENCLOSE / S.V.P. JOINDRE
            Send cheque or Money Order payable to Judo Canada                      Envoyer un chèque ou mandat poste au nom de Judo Canada
            $20     Basic passport application fee                                 20$         Frais pour demande de passeport ordinaire
          + $5      Rush request                                                 + 5$          Demande accélérée
          + $15     If courrier is required                                      + 15$         Pour frais de poste prioritaire si nécessaire



            Copy of Birth Certificate or Proof of Citizenship                      Copie du certificat de naissance ou preuve de citoyenneté
            2 Photos                                                               2 Photos




                  Photo
              1.25" x 1.75"


                                                       Signature - Applicant



                                                                       Date
                                                                                  DJ       MM           YYAA



                  PLEASE PRINT IN BLOCK LETTERS / S.V.P. ÉCRIRE EN CARACTÈRES D'IMPRIMERIES



                       Last Name / Nom de Famille                                                        First Name / Prénom



                                                                   Address / Adresse



                                 City / Ville                                          Prov.                          Postal Code / Code Postal



                              E-mail / Courriel                                                   Telephone # (h) / No. téléphone (d)



                       Name of Dojo / Nom du Dojo                                                 Telephone # (w) / No. téléphone (t)


    Citizenship           Canadian / Canadienne                                          Male / Homme
    Citoyenneté
                          Permanent Resident / Résident Permanent                        Female / Femme


                          Other / Autre:                                       Birthdate / Date de Naissance
                                                                                                                                DD       MJ    YYAA
For Judo Canada office use only.
Section réservée à l'usage du bureau.                                                                  Passport Number


                                                                                                       Date Issued

								
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