Application for Kyu & Dan Grading Examination

Please consult your instructor before completing this form.

Ensure that you use sentence case when filling out the form – please do not use UPPER CASE or all lower case.

Example for correct entry is: John Smith, 38 Smith Street, Auckland.

Upon completion and payment of your grading application both you and your Dojo Cho will receive a detailed copy.

Online payment can be made through PayPal. If you don’t have a PayPal account you can use a credit card to pay via PayPal.

Personal Details
Name*
First Last
Alternative name
If you would prefer a different name on your certificate please enter it here (ie non-latin text).
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female
Nationality*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Occupation*
Phone*
Email*
Enter Email Confirm Email
Grading and Training Information
Training Dojo*
Please select the Dojo where you usually train.
Current Grade*
Date of last grading
When did you obtain your current grade (if graded)?
Date Format: DD slash MM slash YYYY
Last Grading Dojo
Where did you obtain your current grade?
Date of upcoming examination*
Date Format: DD slash MM slash YYYY
Grade you are applying for:*
Please select the grade that you will be applying for at the upcoming grading.
Aikikai Membership Details
Aikikai membership number
Date of Aikikai registration
Date Format: DD slash MM slash YYYY
Shinryukan Membership
Have you paid your membership fees for this year?*
- Yes
- No
Date of Shinryukan membership payment
Date Format: DD slash MM slash YYYY
Membership fees
Your membership fees must be paid before you grade please select the appropriate rate below and it will be added to your grading fee.
Confirmation and Payment
Confirmation*
- I hereby make my application.
Grading Fee
The amount below is the grading fee for your next grading. Clicking on 'Apply & Pay' will take you to PayPal to process your payment.

You can choose to pay by Visa, Mastercard, American Express or by PayPal if you have an account.

Rokudan and Godan applicants please discuss payment with Takase Shihan.
$ 0.00
Comments
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Application for Kyu & Dan Grading Examination

Personal Details

Grading and Training Information

Aikikai Membership Details

Shinryukan Membership

Confirmation and Payment