Region 8 Leadership Program Application Form

Region 8 Leadership Program Application Form

Membership in this program offers members opportunities to broaden and deepen their Tang Soo Do training, leadership skills, and involvement as servant leaders in the Region and Association. Please consider the requirements and commitment as you apply.
Minimum requirements for admittance to the Leadership Program are listed below.
- The Sam Dan applicant or their instructor must complete the Applicant Information section and submit it.
- The Applicant's Instructor will review the form, add their input, and send it to the Regional Director (via JotForm) for approval.
Leadership Class members must be serious about advancing their martial arts knowledge, as well as supporting their dojang and Region.
Applicant's Contact Information

Complete this section with contact information for this applicant. If you are not sure of some information, scroll down, select "Save" and return to complete the form once you have the required information.
Applicant's Name

First Name Middle Name Last Name Suffix
Applicant's Phone Number
Please enter a valid phone number.
Applicant's Email

Confirmation Email example@example.com
Applicant's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Applicant's Tang Soo Do Information

Complete this section with Tang Soo Do information for this applicant. If you are not sure of some information, scroll down, select "Save" and return to complete the form once you have the required information.
The Sam Dan applicant must have/be/demonstrate the following:
- at current rank for at least two years (since date of promotion)
- in good standing and with all dues current with their studio, Region, and WTSDA (as appropriate)
- current and consistent certification as Instructor
- excellent attendance and participation in studio and at Regional and WTSDA classes/events
- exemplary dedication, participation, teaching and leadership skills
Enter information supporting the applicant's request to join the Region 8 Leadership Class and attach requested certificate(s) and supporting information below.
Applicant's Dan #
Please enter WTSDA Dan #
Applicant's Studio
Please select the applicant's studio
Instructor's Email

Confirmation Email example@example.com
Applicant's Sam Dan Promotion Date

Month Day Year
Date of promotion to Sam Dan (July or December)
Please note the applicant's Dan membership status [If Gold Member, include Gold Membership #, if possible or if Dan Member, include Dan Membership Expiry Date]

Gold Member Dan Member
Please note the applicant's Gold Membership # Gold Membership #
Please note the expiration date of the applicant's membership Dan Membership Expiry Date .
Applicant's Dan Membership Expiry Date

Month Day Year
Expiry Date of Dan Membership
File Upload - Supporting Information (optional)

Cancel of
Applicant's Instructor Certification History

Complete this section with the requested information for this applicant. Please enter information below about the applicant's instructor certification history, e.g. years certified by WTSDA, current certification status. Attach a copy or scan of the current instructor certificate below. If you are not sure of some information, scroll down, select "Save" and return to complete the form once you have the required information.
Applicant's Instructor Certification History
e.g. years certified by WTSDA, current certification status
File Upload - Instructor Certification*

Applicant's current Instructor Certificate and any additional supporting information about instructor certification history
Cancel of
Applicant's Signature

If Applicant enters data, please sign here. Clear
Applicant Signature Date

Month Day Year
Date

Instructor Recommendation
The Recommending Instructor

The instructor recommending this applicant is to complete this section.
Instructor's Name *

First Name Middle Name Last Name Suffix
Instructor's Dan # *
Please enter WTSDA Dan #
Instructor's Studio
Please select the Instructor's studio
Please describe the applicant's attendance and participation in your studio
Please describe the applicant's attendance and participation in Regional and WTSDA classes/events
Please offer specific examples of the applicant's exemplary dedication, participation, teaching, and leadership in their studio, the Region, and WTSDA
Instructor's Recommendation
Instructor's Recommendation
Instructor's Signature *

Clear
Instructor Signature Date *

Month Day Year
Date
- Click Save to save and return to the form at a later time.
- Click Submit to submit your input and decision on this applicant.

Regional Director Review
Regional Director Approval

Approved Denied
If denied, reason:
Regional Director Signature

Clear
Regional Director's Review Date

Month Day Year
Date
R8_Leadership_Class_Application_Nov2020
Should be Empty:

Region 8 Leadership Program Application Form

Applicant's Contact Information

Applicant's Tang Soo Do Information

Applicant's Instructor Certification History

The Recommending Instructor