Thursday, December 02, 2021 09:31 PM

Forms

The following supplemental documents are the forms needed for applications. Please apply through your HTSB online account before submitting these forms. Completed forms should be uploaded to the Documents tab of your HTSB account.

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HTSB Form LA3009:

To verify completion of an Educator Preparation Program (EPP)  that is not based in Hawaii.  This includes programs based in other states, District of Columbia, and US territories of Guam, Commonwealth of the Northern Mariana Islands, U.S. Virgin Islands, and Puerto Rico.

Applications from individuals who completed an out-of-state teacher preparation program must be accompanied by a copy of a valid unrevoked license/certificate/credential from another jurisdiction.

Individuals who completed a Hawaii EPP do not need to submit this form as their program will be verified electronically by the EPP.

LA-3009-revised-11-2021

(Revised form required to be used for all new applications  9/17/21)

 

Note: Effective Immediately, see board adopted requirements for any individual seeking a Hawaii license who has completed an out-of-state teacher preparation program and has not acquired a full license or certificate from a U.S. state, District of Columbia, or U.S. territory.

  • All documentation is required to support the LA3009

HTSB Form EX1000:

To verify experience to qualify for a Standard or Advanced License, or to Add a Field to a License.

Hawaii DOE teachers do not need to submit this form as their experience will be verified electronically by the DOE.

EX-1000-Experience Form

 

HTSB Form OS:3009:

To verify a license from another state.  This includes professional educator licenses issued by other states and US territories of Guam, Commonwealth of the Northern Mariana Islands, U.S. Virgin Islands, and Puerto Rico.  The other jurisdiction may also verify your basic skills and content knowledge on this form.

OS 3009 Agency Confirmation of License

HTSB Form Trade or Industry EX:

This form is used to verify trade or industry experience for a Career and Technical Education field or Computer Science field.

CTE Trade or Industry Experience Verification
HTSB Form RA4010:

Non-Hawaii public school teachers use this form to verify employment for license renewal.  Hawaii DOE and Charter School teachers will have their experience verified electronically.

RA-4010-Verification-of-Experience-2021

HTSB Form RA5010:

Verification of Satisfying Hawaii Teacher Performance Standards:  This form helps you record how you verify that you meet the teaching standards.  Hawaii DOE teachers who had a satisfactory evaluation during the term of the license they are renewing will be verified electronically by the DOE.

RA 5010 Standards Teachers
HTSB Form RA5010 C:

Verification of Satisfying Hawaii Counselor Performance Standards:  This form helps you record how you verify that you meet the counseling standards.  Hawaii DOE counselors who had a satisfactory evaluation during the term of the license they are renewing will be verified electronically by the DOE.

RA 5010 Standards Counselors

HTSB Form RA5010 L:

Verification of Satisfying Hawaii Librarian Performance Standards:  This form helps you record how you verify that you meet the librarian standards.  Hawaii DOE librarians who had a satisfactory evaluation during the term of the license they are renewing will be verified electronically by the DOE.

RA 5010 Standards Librarians

HTSB Form Voluntary Removal of License Field:

This form is used to request that a field is removed from your current license.  Once removed a field can only be added by meeting the requirements in effect at that time.

Request to Remove License Field

HTSB Form Voluntary Surrender of Hawaii Teaching License, Permit, or Certificate

This form is used to request surrender of an active teaching license, permit, or certificate for a variety of reasons. Please be sure to complete all fields on the form.
Request to Surrender a License, Permit, or Certificate