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Black Belt Test Application

Complete and submit this application to express your intent to test for Black Belt. Filling out the application does not guarantee eligibility — candidates must meet all requirements, including time in grade, attendance, and performance standards.


Payment will not be accepted until you pass the 2nd Prescreening. Read all instructions carefully, make your selections for additional items, and sign at the bottom.

Next Black Belt Testing

2024 December 30th Black Belt Test

  • There is NO MAKE UP TESTING process.

  • All information contained on this page pertains to the next Black Belt Test.

 

Candidates must submit this Black Belt Test Application by:

0/0/0000 to 0/0/0000

Read This First!!!

This form may time out if left open too long. Please read through everything first, ensure you understand it, refresh the page, then complete and submit the application.

Applicant
Belt Size

Applicants Information

Gender

This Application Is To Test For:

Program
Target Rank

Belt Size

One rank-appropriate belt is included with the Black Belt testing. Additional belts must be ordered no later than the 2nd Prescreening during any Black Belt Testing rotation.

Note

  1. Belt Size: It is recommended to increase your belt size by one when advancing from a Brown Belt Rank to a Black Belt Rank.

  2. Other Options: Larger senior belt sizes are available. Please select “Larger Belt Size” and contact AIK for further information.

  3. Length: The length of the belt can vary by up to 5 inches.

American Institute of Kenpo (AIK) Karate Martial Arts Spirit Towel

Black Belt Size Chart

Belt Size

Size 1

Size 2

Size 3

Size 4

Size 5

Size 6

Size 7

Size 8

Size 9

Size 10

Senior Belt

95"

100"

105"

110"

115"

120"

125"

130"

135"

140"

Junior Belt

92"

97"

103"

109"

114"

120"

128"

139"

Please Select Your Belt Size:

Each additional belt in this size is:

$80.00

Rank Certificate

The American Institute of Kenpo will provide one 13” x 19” Rank Certificate with the Black Belt testing.

American Institute of Kenpo (AIK) Karate Martial Arts Black Belt Certificate

Please Select The # Of Additional Certificates:

Each additional Rank Certificate is

$80.00

Challange Coin | Optional

The American Institute of Kenpo offers Black Belt Challenge Coins as an optional item. Participants may order them during the application process or no later than the 2nd Prescreening.

American Institute of Kenpo (AIK) Karate Martial Arts Challenge Coin

Please Select The # Of Additional Challange Coins:

Each additional Challenge Coin is:

$80.00

Commemorative Shirt

The American Institute of Kenpo will furnish one commemorative shirt to each candidate.


Additional shirts will be available for purchase through the Online Shop or by ordering no later than the 2nd Prescreening.

American Institute of Kenpo (AIK) Karate Martial Arts Commemorative Shirt

Please Select Your Shirt Size:

Each additional Commemorative Shirt is:

$80.00

Please Select The # Of Additional Shirts:

Lineage Print | Optional

Each 13” x 19” Black Belt Lineage Print, featuring your name, is typically priced at $100.00.


When you order a Black Belt Lineage Print at the time of your Black Belt Test (no later than the 2nd Prescreening), you will receive a 20% discount.

American Institute of Kenpo (AIK) Karate Martial Arts Lineage

Please Select The # Of Lineage Prints:

Each Lineage Print is:

$80.00

Black Belt Keychain | Optional

Black Belt Keychains can be ordered prior to the 2nd Prescreening during any Black Belt Testing rotation by any Black Belt.


Please note that the price varies depending on the rank.

American Institute of Kenpo (AIK) Karate Martial Arts Black BeltKey Chain

Please Select The # Of Keychains:

Senior Rank Keychains

$80.00

$80.00

$80.00

$80.00

$80.00

Junior Rank Keychains

$80.00

$80.00

$80.00

$80.00

$80.00

Meal Choice

During the Black Belt Testing process, the American Institute of Kenpo will provide lunch. While we will endeavor to accommodate your dietary requirements, if your specific needs necessitate extraordinary provisions, you may wish to bring additional food.

 

Please confirm your meal preferences during the week preceding the belt testing.

Meal Selection Due By:

0/0/0000 to 0/0/0000

Requirements & Acknowledgments

Black Belt Promotion Eligibility

Please acknowledge that you (and your parent/guardian if under the age of 18) understand the following prerequisites for eligibility to test for Black Belt:

1st Prescreening Date

​November 27th - December 1st, 2023

All candidates will be evaluated by a qualified senior-ranking black belt. You will demonstrate your current knowledge of the required information, including all techniques and forms learned to date.

2nd Prescreening Date

Jan 15th - Jan 19th, 2024

All candidates will be evaluated by a qualified senior-ranking black belt. You will demonstrate and be evaluated on your knowledge of the required information, including all techniques and forms you have learned to date.


The techniques, forms, and sets for the current rotation being tested must be prepared for belt test presentation.

 

Note:

  • Candidates must meet the required performance standards to avoid being removed from the testing list.

Payment Due Date

January 19th, 2024

The payment for the Black Belt test is due. This is your final opportunity to modify your Additional Belt Test Item(s) list.


Effective from this date, no refunds will be processed for orders that have been placed.

Book Report Due Date

(Senior Ranks Only)

January 19th, 2024

Black Belts should possess a comprehensive understanding of the historical evolution of martial arts. This knowledge helps you comprehend the contemporary physical, mental, and emotional benefits derived from these practices, as well as how they have been applied throughout history. Candidates are not only required to read the specified books but are also encouraged to reflect on the lessons learned and consider how they can be applied to their daily lives with honor and integrity.


Additionally, candidates are required to compose a concise essay summarizing their insights gained from the read book.

Candidates testing for 1st Degree Black Belt:

Bushido by Inazo Nitobe

Candidates testing for 2nd Degree Black Belt:

The Art of War by Sun Tzu

Candidates testing for 3rd Degree Black Belt:

Meditations on Violence by Sgt. Rory Miller

Candidates testing for 4th Degree Black Belt:

The Gift of Fear by Gavin De Becker

Candidates testing for 5th Degree Black Belt:

Book of 5 Rings by Miyamoto Musashi

Value Report Due Date

January 19th, 2024

All Black Belts should possess a comprehensive understanding of traditional values. This understanding serves as a counterbalance to the potentially destructive knowledge they acquire. All candidates are required to submit a comprehensive report detailing their understanding of the value assigned for their rank.


The report should include a detailed description of the value from their perspective, explaining how they perceive it benefits others, and providing examples of how they have applied it in their personal lives.

Candidates testing for 1st Degree Black Belt:

Trust

Candidates testing for 2nd Degree Black Belt:

Perseverance

Candidates testing for 3rd Degree Black Belt:

Humility

Candidates testing for 4th Degree Black Belt:

Courtesy

Candidates testing for 5th Degree Black Belt:

Mastery

3rd Prescreening Date

​Feb 19th - Feb 23rd, 2024

All candidates will be evaluated by a qualified senior-ranking black belt. You will demonstrate and be evaluated on your knowledge of the required information, including all techniques and forms you have learned to date.


The techniques, forms, and sets for the current rotation being tested must be prepared for belt test presentation.

 

Note:

  • Candidates must meet the required performance standards to avoid being removed from the testing list.

  • Candidates removed from the testing list at this juncture will not be eligible for a refund.

Black Belt Test & Promotion

June 21st, 2024

Candidates are required to attend the belt test to be promoted. Further details are available on the Black Belt Testing Process & Test Information page.

 

Note:

  • There is NO MAKE UP TESTING process. Students who are unable to attend the testing process for any reason will not receive a refund.

Participation Agreement

The American Institute of Kenpo, all instructors, and associates will hereby be referred to as the Presenters.

WAIVER OF RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY

In consideration of your acceptance as a member of and participant in the AIK Black Belt Test and Rank Promotion, I do hereby, for myself, my heirs, executors and administrators waive, release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless any and all rights and claims for damages which I may have or may accrue to me against the Presenters of the AIK Black Belt Test and Rank Promotion, owners and leasers of premises on which the AIK Black Belt Test and Rank Promotion is located and against any participant for any and all damages which may be sustained by me, in connection with and my association with the AIK Black Belt Test and Rank Promotion including those which may arise out of travel to, participation in, and returning from the AIK Black Belt Test and Rank Promotion.

I understand the nature of the activities and believe that my experience, health, and capabilities to be qualified to participate in the AIK Black Belt Test and Rank Promotion and associated athletic events, trainings, classes, and/or seminars. I understand that when participating in any sport, athletic event, training, class, and/or seminar there is inherent risk and therefore this may involve risk and dangers of bodily injury, including permanent disability, paralysis, and death. These risks and dangers may be caused by my own actions, or inactions and/or the actions of others participating at the Presenters facilities, and athletic events/trainings/self defense and health related seminars and classes to include the AIK Black Belt Test and Rank Promotion. I acknowledge that it is recommended that before undergoing any form of exercise, an examination or consultation with your doctor is suggested.

COVID-19 WAIVER

I understand and acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed or infected by COVID-19 by visiting the Presenters facilities and premises, and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, and I completely release, covenant not to sue, discharge, and hold harmless the Presenters, agents, owners, representatives, and employees from any and all liabilities, claims, suits, actions, losses, damages, costs or expenses of any kind if I do become exposed or infected. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Presenters, and the employees, agents, owners, representatives, and employees, whether a COVID-19 infection occurs before, during, or after visiting the Presenters facilities and premises and/or my participation in any of the Presenters events.

Refund Policy

I understand and acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed or infected by COVID-19 by visiting the Presenters facilities and premises, and that such exposure or infection may result in personal injury, illness, permanent disability or death. I understand that the risk of becoming exposed or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, and I completely release, covenant not to sue, discharge, and hold harmless the Presenters, agents, owners, representatives, and employees from any and all liabilities, claims, suits, actions, losses, damages, costs or expenses of any kind if I do become exposed or infected. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Presenters, and the employees, agents, owners, representatives, and employees, whether a COVID-19 infection occurs before, during, or after visiting the Presenters facilities and premises and/or my participation in any of the Presenters events.

Should I pass the 2nd Prescreening, and I submit payment, all requested items will be ordered. I understand that, due to the nature of these items, there will be no refund for those items I requested nor will I receive those items until such time as I successfully complete the AIK Black Belt Test and Rank Promotion.

 

I understand, assuming that I can successfully complete the requirement to be eligible, that select items can be held for the next AIK Black Belt Test and Rank Promotion. Items that cannot be held include the Rank Certificate and the Black Belt Test Commemorative Shirt. I acknowledge that to participate in any future AIK Black Belt Test and Rank Promotion that I will need to submit additional payment for the relevant Rank Certificate and the Black Belt Test Commemorative Shirt.

CONSENT TO ATTEND

I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without an inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by the law and agree that if any portion of this agreement is held to be invalid that the balance, notwithstanding, shall continue in full force and effect.

I fully understand that any medical treatment given to me will be First-Aid type treatment only.

I further consent that any pictures furnished by me or any pictures taken of me in connection with any activities can be used for publicity, promotion or media showing, and I waive compensation in regard thereof.

ACKNOWLEDGMENT OF APPLICATION AND ACCEPTANCE


The undersigned applicant has read and understands the provisions of this application and acknowledges that no other verbal agreements have been made. The applicant accepts all provisions of this application.

 

In the event that the applicant is not of legal age (if under 18) the parent/legal guardian attests that they have read the provisions of this application with the applicant. The undersigned parent/legal guardian and the applicant both acknowledge and understands the provisions of this application and acknowledges that no other verbal agreements have been made. The parent/legal guardian and the applicant accepts all provisions of this application.

Acceptance of Requirements

The undersigned applicant has read and understands the provisions of this application and acknowledges that no other verbal agreements have been made. The applicant accepts all provisions of this application.


In the event that the applicant is not of legal age (if under 18) the parent/legal guardian attests that they have read the provisions of this application with the applicant. The undersigned parent/legal guardian and the applicant both acknowledge and understand the provisions of this application and acknowledge that no other verbal agreements have been made. The parent/legal guardian and the applicant accept all provisions of this application.

The Applicant

The Legal Parent Or Guardian, If Under 18years Old

Parent’s/Legal Guardian’s information and consent is required if the Applicant is under 18 years old.

Submit This Application For Review

When you click the Submit Application button, this information will be submitted for review.


Upon successful submission, a confirmation message will appear here.

Your Application Has Been Submitted!

Coin
Shirt
Lineage
Keychain
Meal
Requirements
Acceptance
Certificate
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