Regular Chuo Shinsa Application (Shogo, Rokudan and Above)

Shinsa Application Form
To the President of the All Nippon Kyudo Federation

(For Shogo/Rokudan and above)
Your email*
enter your email address to receive confirmations
Which State Renmei Head will approve your application?*
This is your state federation, NOT your dojo affiliation
Choose your dojo leader here. Your application will be sent to your dojo leader for approval BEFORE being sent to the State Renmei Head.
If your dojo leader is no on this list, please go on to the next question.
Dojo Leader Email
will be automatically entered by previous choice
State Renmei Leader Email*
will be automatically entered by previous choice
Your Information
Today's Date*

YearMonthDay
Full Name (English)*

First Name (English)Last Name (English)
Full Name (Japanese)

First Name (Japanese)Last Name (Japanese)
Date of Birth*

YearMonthDay
Date of Birth
Age on Day of Shinsa*
Gender*

MaleFemale
Address
Include city, state, zip and country

Shinsa Ranks

Current ranks & those for which you are testing
Shinsa Category*
Rank for which you are testing
Present Dan Rank*
Present rank you currently hold
Date Obtained (Current Dan rank)*

YearMonthDay
Date
Name of Shinsa (for Dan Rank)*
Present Shogo Certification
Present shogo you currently hold
Date Obtained (for Shogo Certification)

YearMonthDay
Date
Name of Shinsa (for Shogo)

Date of Promotions (Year/Month)

Rank History (YYYY/MM)

	Year	Month
Shodan
Nidan
Sandan
Yondan
Godan
Rokudan
Renshi

ANKF/IKYF Taikai Accomplishments

Enter most recent accomplishments first
Year
Most recent taikai accomplishment
Month
Most recent taikai accomplishment
Placement
Include placement & location of taikai

2nd Most Recent Taikai Accomplishment
Year
2nd most recent taikai accomplishment
Month
2nd most recent taikai accomplishment
Placement
Include placement & location of taikai

3rd Most Recent Taikai Accomplishment
Year
3rd most recent taikai accomplishment
Month
3rd most recent taikai accomplishment
Placement
Include placement & location of taikai

4th Most Recent Taikai Accomplishment
Year
4th most recent taikai accomplishment
Month
4th most recent taikai accomplishment
Placement
Include placement & location of taikai

Positions Held (International, National or Local)

Enter most recent positions first
Year
Most recent position held
Month
Most recent position held
Position Details
Most recent position held

2nd most recent position held
Year
2nd most recent position held
Month
2nd most recent position held
Position Details
2nd most recent position held

3rd most recent position held
Year
3rd most recent position held
Month
3rd most recent position held
Position Details
3rd most recent position held

4th most recent position held
Year
4th most recent position held
Month
4th most recent position held
Position Details
4th most recent position held

Instructor Degree including other sports
Enter degree & sport organization
Blank Years

Dates and reason for significant gaps in your kyudo training
Year
Year your training gap began
Month
Month your training gap began
Year
Year your training gap ended
Month
Month your training gap ended
Reason
Enter reason for the gap in training

Name of Shinsa
Date

YearMonthDay
Date
Venue
Remarks
Rissha or other pertinent information
IKYF ID Number

Enter each digit in it's own field to ensure it lays out on the form clearly.

IKYF ID Number

	Digit 1	Digit 2	Digit 3	Digit 4	Digit 5	Digit 6	Digit 7
ID Number

Signature section
Name of National Federation Association
Applicant's Signature*

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