United States Imperial Society of Teachers of Dancing

Medal Tests and Examinations Roster

Please print or type all requested information

Particulars of Examination Venue and Organizer

Studio Name: / Organizer’s Name:
St. Address: / City: / ST: / Zip:
Phone: / Fax: / Examiner: / Exam Date:
YOUR CERTIFICATES AND MEDALS WILL BE MAILED TO THE ABOVE ADDRESS.
Instructions for Examination Organizer /

Age Categories

1. / Use these instructions to fill out the Roster on the following page(s) /

Abbreviation

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Age Requirements

2. / Fill in all requested information BEFORE the Examiner arrives / Juv = Juvenile / Under 12 years of age
3. / List candidates in the order in which they will dance, confirming spelling of all names. The names will appear on the certificates as entered on this form. / Jr = Junior / 12 years of age through 15 years of age
Y = Youth / 16 years of age through 17 years of age
4. / If a candidate is taking multiple exams (e.g. Bronze W, Q BronzeT, F), use a separate line for each exam. / Ad I = Adult I / 18 years of age through 49 years of age
Ad II = Adult II / 50 years of age through 64 years of age
5. / Amateur Gold Star & Professional Diploma tests, mark at which level the candidate will dance (1, 2, or 3) / Sr I = Senior I / 65 years of age through 84 years of age
6. / DA 2, 3stands for Dance Achievement2, 3. These tests consist of 2
or 3 dances respectively. / Sr II = Senior II / At least 85 years of age
Age Categories / are not included on the certificates
7. / Using the ‘Dance Codes Chart’ below, enter the appropriate initial letter(s) of the dance(s) being examined. / Pro = Professional / See Exam Handbook for Minimum Ages and Other Requirements
8. / For Professional Exams, enter Pro under Age Div.
9. / The ‘Result’ column will be filled in by the Examiner / * Intermediate Levels, One-Dance and ‘Other’:
Intermediate levels are available for Bronze, Silver, and Gold Medal Tests. Write “Int. Br., Int. Sil. Or Int. Gold.
Candidates may dance a Medal Test as a one-dance exam. Write the examination level plus “One”.
Candidates may dance a Medal Test as the opposite gender. Write the examination level plus As Follower (AF) or As Leader (AL).
Available Exam Levels / Exam Types / Result Codes /

Min

DA 2, 3 / Formation / A Ballroom / H = / Honors - Medal Tests / 85+%
Intermediate* / Imperial Technical / A Rhythm / HC = / Highly Commended – Professional Certifications / 85+%
Bronze / Diploma 1, 2, 3 / I Ballroom
Silver / Student Teacher / I Latin / C = / Commended / 75+%
Gold / Associate / Alt Rhythm / P = / Pass / 65+%
Gold Star 1, 2, 3 / Licentiate / F = / Fail / -65%
One-Dance & Other* / Fellow

Dance Codes Chart

Am / Int’l:
Alt Rhythm: / W = Waltz; T = Tango; F = Foxtrot; Q = Quickstep; VW = Viennese Waltz; P = Peabody; R = Rumba;
J = Jive; Sw = Swing; C = Cha Cha; S = Samba; PD = Paso Doble; M = Mambo; B = Bolero
H = Hustle; WCS = West Coast Swing; Mer = Merengue; AT = Argentine Tango; LH = Lindy Hop; Sal = Salsa

Roster of Candidates and Their Examination Particulars


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Updated 6/24/16