ITA Black Belt Grading Application Form Dec. '23

The Black belt grading will take place on Sunday Dec 3rd in two regions on the same day to save in travel & overnight costs for the majority of candidates:

Venue 1: CBS National School, Ennis, Co. Clare

Venue 2: Scoil Bhríde, Kilcullen, Co. Kildare R56 RK83

The Deadline for submitting applications is Sunday Nov 19th

A photo (head & shoulders/passport style) of each candidate must also be submitted on applying to sryan@taekwondo.ie. The photo must be saved as the name of the candidate so they can be easily identified. 

Please note that all fees must be transferred to the ITA account by the deadline of Nov 20th using the candidates name as reference. It is not possible to pay on the day of the grading. 

For a breakdown of fees & the ITA Acc. information please visit this link on the ITA website; https://www.taekwondo.ie/blackbelt-grading

Only complete applications which include the online form, emailed photo & full fee paid by the deadline will be accepted. 

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Email *
Please choose the location in which you wish to test. Munster based candidates should choose Co. Cork as location, Leinster based candidates should choose Co. Dublin as their location. Candidates based in more peripheral locations please choose the location which is most convenient.  *
Candidate full name (ensure correct spelling) *
Candidate Age (minimum age 13) *
Date of Birth *
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Nationality *
Gender *
Last promotion date (please ensure you have met the requirements to be eligible to test in line with ITF & ITA bylaws) *
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Current grade *
ITA School Name *
Instructor's Name *
Candidate email *
Candidate phone number *
Have you completed an ITA Preliminary Black Belt test prior to this black belt grading *
Date of Preliminary Black Belt grading *
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Name of examiner who conducted the Preliminary black belt grading *
Note; Any issues that are relevant to the performance of a candidate and their subsequent grading result must be presented in writing with the grading application (e.g. applying for an executive grade, medical, physical, psychological), a doctor’s note to accompany where appropriate. These items will be discussed, initially by the technical director, with the instructor of the candidates and subsequently with the panels in advance of the test. All such information will be treated with discretion and in confidence. Please email details to the ITA Secretary General (sryan@taekwondo.ie) when applying to test.
Are you taking any form of medication for any cardiac condition (including aspirin & warfarin) ? *
Do you or have you felt a sensation of "blacking out" during or after training? *
Do you or have experienced any chest pains or chest tightness during or after physical activity? *
Do you have a diagnosed bone or joint condition that could be aggravated by physical activity? *
Are you aware, through your own experience or on medical  advice, of any  reason why you should not take part in strenuous high intensity physical activity ? *
Is your BMI greater than 28 ? *
Are you pregnant, or have you been pregnant in the past three months? *
Are you aware, through your own experience or a doctor’s advice, of any reason why you should seek medical approval before engaging in any form of exercise? *
If you answered yes to any of the above questions you will need a letter from your GP stating that you are "medically fit to take part in a Black Belt Grading"
Do you have any special needs or requirements that the examiners should be made aware of? *
If there is any other condition which may affect participation which the examiners panel should be made aware of? *
Do you accept that participation in the grading involves high intensity activity and the risk of injury? *
Date & Place of any IICs completed during preparation period (Applications for 4th Degree and above)
Do you have a valid ITF plaque? (All ITA instructors, assistant instructors & examiners must have an up to date ITF plaque, if you do not currently have one please include the 40 Euro annual fee with the application) *
All candidates applying for 4th Degree and above must also apply for an ITF international instructor certificate. You must include the fee (150 Euro) along with the testing fee. You must also complete the ITF online exam as part of the certification process. Email the ITA Secretary General (sryan@taekwondo.ie) for more information. Those testing for 4th Degree and above must have completed the online exam prior to the black belt grading. 

I confirm I have included the International Instructor fee and I acknowledge the online exam must be completed prior to grading
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Please refer to the ITF & ITA Bylaws to make sure you meet all the requirements to be eligible to test. Further information regarding the ITA Black Belt grading including the fee structure & syllabus are available on the ITA website at this link; https://www.taekwondo.ie/blackbelt-grading
A copy of your responses will be emailed to the address you provided.
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