EmailMe Form - USA Judo National Resident Team Application

Contact Information

Name
First Last

Phone
### - ### - ####

Date of Birth
MM / DD / YYYY

Email

Address

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

Height
Example: 5 ft 10 in

Weight
Example: 185 lbs

Weight Category

Home dojo/club name

Are you a citizen of the United States?
Yes
No
No but hold official IJF Refugee Status

Home/Personal Coach Information

Name
First Last

Address

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

Phone
### - ### - ####

Email

Training History

Background in Judo

Total years in judo

Total years in competitive judo

Total years in judo
Total years in competitive judo

Training Frequency/Intensity (Hours)

2022

2023

2024

List estimated number of hours in each year

2022
2023
2024

Training Frequency/Intensity (Total Sessions)

2022

2023

2024

List estimated number of training sessions each year

2022
2023
2024

Training Sessions per Week in 2024

Average

Maximum

Minimum

List estimated number of training sessions for each category

Average
Maximum
Minimum

Do currently you have a written training plan?
Yes
No

Do you currently have a training diary/log?
Yes
No

Competition Results History

Best NATIONAL and INTERNATIONAL results within the last two (2) years:

Name of Competition Finish Number of Fights Comments

Result 1

Result 2

Result 3

Result 4

Result 5

Result 6

Result 7

Result 8

Result 9

Result 10

IJF Senior/Junior Ranking List

Current

2024

2023

Current
2024
2023

USA Judo National Senior/Junior Ranking List

Current

2024

2023

Current
2024
2023

Number of competitions attended within the last year

Athlete Assessment

Use scale from 1-5 (5 - World Class, 3 - National Level, 1 - Local Level) *BOTH the athlete and his/her personal coach must complete the assessment

Rating

Technical judo

Physical Fitness

Mental Fortitude ex. ability to handle stressful situations

Tactical judo ex. ability to execute a game plan and adapt during matches

Character ex. sportsmanship, ability to handle adversity

Knowledge/Experience ex. experience within international competition and training settings

	Rating
Technical judo
Physical Fitness
Mental Fortitude ex. ability to handle stressful situations
Tactical judo ex. ability to execute a game plan and adapt during matches
Character ex. sportsmanship, ability to handle adversity
Knowledge/Experience ex. experience within international competition and training settings

Athlete Self-Reflection
List strengths AND weaknesses of the athlete in the following sections

Technical Judo

Strength

Weakness

Strength
Weakness

Physical Fitness

Strength

Weakness

Strength
Weakness

Mental Toughness

Strength

Weakness

Strength
Weakness

Tactical Judo

Strength

Weakness

Strength
Weakness

Character

Strength

Weakness

Strength
Weakness

Home Environment/Support

Does your home club have a history of developing world level athletes?
Yes
No

Does your home club provide financial support for high performance judo?
Yes
No

Does your home club emphasize training for international competitions as opposed to local national?
Yes
No

Do you and/or your home dojo have a long-term plan for sustained high performance judo?
Yes
No

Does your home club provide ample equipment for high performance judo?
Yes
No

Does the athlete receive strong support from friends and family?
Yes
No

Summary

Briefly summarize how the USA Judo National Resident Team will impact you:

Additional Comments

Provide any additional comments as they may relate to your application to the USA Judo National Resident Team:

Submission

I hereby certify that the information above was completed truthfully and to the best of my knowledge:
Yes
No

Signature
Clear

Date
MM / DD / YYYY

	Name of Competition	Finish	Number of Fights	Comments
Result 1
Result 2
Result 3
Result 4
Result 5
Result 6
Result 7
Result 8
Result 9
Result 10