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 National
Commission
for Certification
of Traditional
Martial
Arts
Manual Application
National
Commission for Certification of Traditional Martial Arts
Must complete
this application and send to: NCCTMA
4724 W., Lovers
Lane, Dallas, TX 75209
NCCTMA STUDENT APPLICATION FORM
APPLICANT AFFIDAVIT
Applicant's Name:__________________________________________
I Certify that I am the person in the attached photograph.
(Photograph of Applicant)
National
Commission for Certification of Traditional Martial Arts
APPLICATION FORM
Name:_____________________________________________ [First,
Middle, Last]
Date of Birth:________________ Sex: M [ ] F[ ]
Home Address:
_____________________________________City__________________
State________ Zip__________
Business
Name:______________________________________________________
Business Address:
__________________________________City____________________
State _________Zip__________
Business Phone: (_____)______________ Home Phone:
(_____)______________
Fax: (_____)_________________ E
Mail_____________________________________
Soc. Sec. No._____________________ Drivers License
#:_____________________
Ethnicity:_____________________
Are you a U.S. citizen: Yes [ ] No[ ]
If not, please
explain:___________________________________________
Languages: Can you speak or write any language other than
English? Yes [ ] No [ ]
If yes, which language (s):
______________________________________________________________________
Correspondence Preference: Home [ ] Business [ ]
I am applying for:__________________________________________
Martial Arts Education, List All Martial Arts Schools Attended:
Name of
school:__________________________________________________________
Address:__________________________________________________________
Years attended:_______________ Graduation Date:______________
Degree (s)
Earned:__________________________
Name of
school:__________________________________________________________
Address:__________________________________________________________
Years attended:_______________ Graduation Date:______________
Degree (s)
Earned:__________________________
1. Have you ever been convicted of a felony or a crime involving
moral turpitude? Yes [ ] No [ ]
If yes, explain:
____________________________________________________________________
2. Have you within the past three (3) years had or do you
currently have any physical or mental illness, drug or alcohol
problems? Yes [ ] No [ ]
If yes, describe: _____________________________________________
3. Are you now or have you ever been a member of any Martial Arts
Association? Yes [ ] No [ ] If yes, please list below.
_____________________________________________________________
4. Have you ever been rejected for membership or denied the
privilege of taking an examination by any martial arts associations?
Yes [ ] No [ ]
If yes, please explain.
______________________________________________________________
5. Have you ever applied to NCCTMA for certification? Yes [ ] No
[ ]
If yes, please explain.
_____________________________________________________________________
APPLICANT'S OATH
I hereby solemnly certify, under oath, that I am the person named
in this application, that all statements I have made, and that the
information contained herein is true.
I acknowledge that I have read all the information provided to me
as an applicant, and I understand that the fee I am submitting is
not refundable.
I hereby release, discharge, and exonerate the
National Commission for
Certification of Traditional Martial Arts , and their
agents or representatives, and any person furnishing information,
from any and all liability of every nature and kind arising out of
the furnishing or inspection of such documents, records, or other
information, in the investigations made by the
National Commission for
Certification of Traditional Martial Arts.
I certify that no prosecution is currently pending against me in
any court in the United States or in any foreign country..
I
recognize that belts are awarded only when specific standards of
performance can be met by the student during
testing. In the event that I may not perform to
the satisfaction of the testing officials, promotion may be delayed
until further progress has been
demonstrated, after a designated period of further practice. If I
do not achieve the desired rank, I
may test again for that rank at the next testing session. I
recognize that promotion standards are
uniform and that each belt reflects a specific
level of competence. If he or she nominated outstanding in the
promotion test, the student
can double test on the next upcoming test to move up another rank at
the same time. Whoever has the
ability may take the advantage to double promote.
I understand in the nature of Martial Arts
in combative activities accidents may occur which may cause injury.
Therefore I, above student, do hereby for
myself, my heirs, executors, administrators and assigns, waive,
release and forever discharge any
and all rights and claims whatsoever for damages which I may have,
or shall hereinafter occur to me,
against my martial arts school, master, instructor or to other
members, for any and all damages
which may be sustained and suffered by me in
connection with my association or entry in any practice, class,
performing in promotion test, or
which may arise out of my travelling to, participating in or
returning from such endeavour.
Applicant's Name (print):_______________________________
Applicant's Signature:___________________________
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