IKCA Test Submission

Contact Information

Email Address *

Full Name (First Last, e.g. John Smith) *

Phone Number *

Shipping Address

Complete Shipping Address (including country) *

Program Information

Is this test part of the IKCA Rank Recognition Program? *

Yes No

Is this test a submission under the IKCA Distance Learning Program OR QI Program? *

Yes No

Who is your CVI / QI Program Mentor?

Diploma Information

Write your name exactly as you want it on your diploma (for a passing test) *

Qualifying / Certified Instructor (QI/CI)

Is this test a submission for a Qualifying or Certified Instructor? *

Yes No

QI/CI Name

Write the name of the student exactly as desired on a diploma for a passing test.

Test Details

Adult (16+) or Junior (<16) rank level? *

Adult (16+) Junior (<16)

Current Rank *

Test Date *

What belt level is this test for? *

Belt Size (if ordering a new belt)

Description of Current Limitations (optional — note any injuries or physical limitations affecting your test)

Test Videos

Your main test video link is required before your submission can be sent. You may paste an existing link (YouTube, Dropbox, Google Drive, etc.) or upload directly to the IKCA YouTube channel.

Test Video * (required to submit)

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Drag & drop your video here, or click to browse

MP4, MOV, AVI, MKV and other video formats accepted

0

Sparring Video Link (Blue Belt through 1st Black Belt — if recorded separately)

Additional Video Links (if you had to split your test into multiple videos, paste all links here)

Submission Received!