WTSDA Student of the Month
Questionnaire

     As a new addition to the WTSDA Kids Zone section of the web site, we would like to implement a Student of the Month, acknowledging students from all over the globe who always put forth 110% effort and help out when they can. In order to be nominated for this section, students must be aged 18 or younger. Rank is not an issue – members from white belt through Sam Dan are eligible. Nominated students must train consistently at a WTSDA sanctioned studio and hold an official WTSDA membership number. A person may nominate themselves or be nominated by a parent, peer or instructor. The entire questionnaire below must be filled out for the nominee to be considered.


Student Name: ____________________________________

Membership #: __________________

Age: _________

DOB:    /   /

1) How long has the student been training in the WTSDA?




2) How does the student assist around the dojang?




3) Why should this student be considered for this honor (be specific, use additional paper if necessary):





4) List any activities/accomplishments outside of the dojang (use additional paper if necessary):





5) Any other information we should know about this student (use additional paper if necessary):



By signing this agreement, I consent to my child's/student's photo, full name and studio appearing on the WTSDA official web site.


Parent Signature: ___________________________________    Daytime Phone #: (     )     -

Instructor Signature: ________________________________    Daytime Phone #: (     )     -

Nominees will not appear on the web site without both, parent and instructor signatures

Please include a hard copy photo or JPEG formatted file of nominee
(preferably in white dobohk) when returning this questionnaire

Return paper copy to your chief instructor or mail to:
WTSDA Kidszone, 709 Oregon Avenue, Philadelphia, PA 19148