4th Kyu - Purple Belt with 2 White stripes (includes intermediate grade - 1 white tag)

Kihon

Sanbon-Zuki x5 forwards, turn Mae-Geri/Sanbon-Zuki
Age-Uke / Mae-Geri / Gyaku-Zuki / Gedan Barai x5 forwards, x5 stepping back
Soto-Ude-Uke / Yoko-Empi uchi / Uraken / Gyaku-Zuki / Gedan-Barai x5 forwards, x5 stepping back
Uchi-Uke (Kokutsu-Dachi) / Kizami-Zuki (in Zenkutsu-Dachi) / Gyaku-Zuki / Gedan-Barai x5 forwards, x5 stepping back
Shuto-Uke (Kokutsu-Dachi) / Mae-Kizami-Geri / Nukite (Zenkutsu-Dachi) x5 forwards, x5 stepping back
Mae-Geri / Mawashi-Geri / Uraken / Gyaku-Zuki / Gedan-Barai x3 forwards, turn, x3 back
Mae-Geri / Kekomi / Shuto-Uchi / Gyaku-Zuki / Gedan-Barai x3 forwards, turn, x3 back
Yoko-Geri-Keage (Kiba-Dachi) / Gyaku-Zuki (Zenkutsu-Dachi) / Gedan-Barai (Kiba-Dachi) x3 forwards, turn, x3 back

Kumite

Kihon Ippon Kumite, Sets 3 & 4 (both sides).  
Attack 5 different attacks with the left, then repeat with the right.

Kata

Heian Godan.
Plus any previous Kata.