HTSB Forms

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.

• (Revised form required to be used for all new applications submitted after 9/19/22)

• 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-Revised-9-19-2022-Experience Form Fillable

(Revised form required to be used for all new applications submitted after 9/19/22)

Note: According to Hawaii Administrative Rules (HAR) 2014, experience is defined as contracted full-time teaching experience in a P-12 setting in Hawaii or another state. 

HTSB Form OS3009:

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.

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.

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.

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.

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.

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.

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.

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

RA6010 T

This form is for non-Hawaii DOE teachers to give their administrators to verify they meet the Hawaii Teacher Performance Standards on their most recent evaluation. This form is a worksheet that is designed to go with the most recent teacher evaluation.

RA6010 C

This form is for non-Hawaii DOE counselors to give their administrators to verify they meet the Hawaii Counselor Performance Standards on their most recent evaluation.

RA6010 L

This form is for non-Hawaii DOE librarians to give their administrators to verify they meet the Hawaii Librarian Performance Standards on their most recent evaluation.

TL7010

Formal Notary Request Form