USAT-MAC :: MVP Candidate Nomination Form

USAT-MAC Chris Canning

MVP Award and Scholarship

Nomination Form

Date-Time Application Submitted

- Month - Day at Year / Hour Minutes

NOTE: The information on this form cannot be saved. Please gather all documentation before beginning.

BACKGROUND

Candidate's Full Name*

First Name Last Name

Candidate's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Best Phone Number*

- Area Code Phone Number

Candidate's Birth Date*

Month Day Year

Age*

Gender*

Male Female

Academic School Attending*

Highest Grade Level Achieved*

Rank in Class

Describe your School Activities (Clubs, Sports, Arts,etc.*

Academic Awards or Honors*

Number of Years in Taekwondo*

My Martial Art Rank*

My Rank is Certified by:*

Years of Tournament Experience*

I have Competed*

Locally State Region (Multi-State Competition) National International

I have won State Titles for*

Forms Team Forms Point Sparring Olympic Sparring Breaking

I have won National Titles for*

Forms Team Forms Point Sparring Olympic Sparring Breaking

List International Competitions and Placements*

Describe other Martial Arts Experience*

Martial Arts School*

Martial Arts School Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Martial Arts Instructor*

First Name Last Name

Martial Arts School Phone*

- Area Code Phone Number

Martial Arts School web address: www. ___*

MOST RECENT YEAR'S TOURNAMENT EXPERIENCE

Give Details of Tournaments Attended: Date; Name; Place; Accomplishment*

Describe your hardest Competitive Challenge*

Describe (with detail) your most significant competitive achievement*

PERSONAL ACCOMPLISHMENTS or ACHIEVEMENTS

How does this Candidate display the required personal attributes - (courage, determination, competitive drive, concern for others, humility)?*

How did this Candidate help someone else in training or competition?*

How does this Candidate stand "head and shoulders" above all others in your school?*

What activities (or part) has the Candidate played in the community in which they live?*

UPLOAD DOCUMENTS

Candidate's Portrait Photo*

Record of Scholastic Achievement*

Documentation of Community Service*

Letter of Recommendation*

CREDENTIAL CHECKLIST

I have met the following Requirements (NOTE: All must be checked):*

Am at least 14 years of age but not yet 25 years Have been an active member of USAT for at least 1 full year Am a competitor at this USAT-MAC Expo Am a First Degee Black Belt or above Have met the Standards: Academic, Martial Arts, Community, Attributes of Award's Namesake, (Artistic is a plus) Have been nominated by Coach, Instructor, Friend or Relative Credentials can be substantiated Application is being submitted before October 1 Nominator agrees to be accessible to the Awards Committee during the evaluation and selection process.

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