Choong Sil Tae Kwon-Do Federation Application for Certified Instructor Program

Transcription

1 Choong Sil Tae Kwon-Do Federation Application for Certified Instructor Program To: Choong Sil Tae Kwon-Do Federation Headquarters: Cost [ ] Certified Instructor Program Level I - $0.00 [ ] Certified Instructor Program Level II - $ 0.00 [ ] Certified Instructor Program Level III - $ 0.00 Enclosed within is my application, registration fee, membership renewal & fee (if expired), CPR and First Aid Certification and signed copy of the Teaching Log. I have also passed both levels of the Tournament Rules Clinic within the last months. of last Rules Clinic. Name Mailing Address Student # (First) (Middle Initial) (Last) ( Address-Print Clearly) DOB (Street) (City) (State) (Zip) Home Phone( ) Work Phone ( ) (Hour ) (Enter only if you can receive calls) Single ( ) Married ( ) Occupation: Full ( ) Part time ( ) Student: Full time ( ) Part time ( ) College or University Present rank in Tae Kwon-Do or other martial art: Name of Instructor Instructor Signature Please include a " X " color picture in uniform. Have you ever been: A. Convicted of a felony? B. Convicted of sexual misconduct? C. Denied membership in any other martial arts organization? I give the CTF my permission to do a criminal background check. Yes No I agree and accept the terms and conditions of the CTF Policy and Ethics Manual, CTF School Owner s Manual and the Manual and all provisions contained therein. Application for Certified Instructor Revised December 0

2 Career Information ) Do you presently teach? Yes No ) Do you presently own and operate a commercial school? Yes No ) Do you work as an instructor at a commercial school owned by another person? Yes No ) Do you presently operate a club or teach a course using someone else's facilities? Yes No ) Do you plan to start a club or teach a course using someone else's facilities? Yes No ) Do you plan to own and operate your own commercial school in the future? Yes No NOTE: Please use Schedule A to explain details on the questions that were answered "yes" above. SCHEDULE A Application for Certified Instructor Revised December 0

3 Verification of CPR Certificate Exam : Location: Issued: Expiration : CPR Instructor Name: Address: (Street) City State Zip Code Telephone Number:( ) Sponsoring Organization: Tae Kwon-Do instructor's Signature: Note: The Tae Kwon-Do Instructor's signature is part of the verification that the CPR course has been successfully completed. Application for Certified Instructor Revised December 0

4 Verification of Basic First Aid Certificate, Exam : Location: Issued: Expiration : Basic First Aid Instructor Name: Address: (Street) City State Zip Code Telephone Number:( ) Sponsoring Organization: Tae Kwon-Do instructor's Signature: Note: The Tae Kwon-Do Instructor's signature is part of the verification that the Basic First Aid course has been successfully completed. Application for Certified Instructor Revised December 0

5 CTF TEACHING LOG Name of Assistant Instructor Tae Kwon-Do School Where Instructing Signature of Instructor 0 Application for Certified Instructor Revised December 0

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