Name of Studio * Name of Teacher (s) * Desired Date of Evaluations * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202420252026 Year Address * City * Province * - Select -AlbertaBritish ColumbiaManitobaNorthwest TerritoriesNew BrunswickNewfoundlandNova ScotiaPrince Edward IslandOntarioQuebecSaskatchewanYukon Postal Code Phone Number * Email * The pricing of the Medal Test Examinations is $15.00 per dance. Make application and payment at least three weeks prior to the Evaluations. It is the Studio’s responsibility to pay for the Examiner’s travel and meal expenses. Medal Tests LIST OF CANDIDATES FOR MEDAL EVALUATIONS Please indicate if Candidate is Junior (16 and under) or Adult (17 and over) • Indicate International Ballroom or Latin, American Style, Smooth or Rhythm in Style Column. • Level of Tests • Number of Dances – Indicate Number of Dances to be presented in each Given NameLast NameJunior/AdultStyle...Level of TestNumber of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Given Name Last Name SelectJuniorAdult Junior/Adult SelectBallroomLatinSmoothRhythmArgentine TangoSalsaBachataNightclub Two-StepHustle Style . . . SelectINT. STYLE BELOWPre BronzeFull Pre-Bronze BronzeFull BronzeSilverFull SilverGoldFull GoldGold StarGold BarSupreme AwardAM. STYLE or OTHER BELOWBronze IBronze IIBronze IIIBronze IV-FullSilver ISilver II-FullGold IGold II-FullGold BarSupreme Award Level of Test Number of Dances Total number of dances * Leave this field blank Continue
