HTSB 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.

HTSB Forms	Download PDF Forms
HTSB Form LA3009: Out-of-State Institutional Recommendation 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.	LA3009 (rev. 09/2022) (Revised form required to be used for all new applications submitted after 9/19/22) 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: *Verification of Employment* 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.	EX1000 (rev. 09/2022) (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: Licensing Agency Confirmation of Licensure 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.	OS3009 (rev. 12/2022)
HTSB Form CTEX2000: Industry or Trade Experience Verification This form is used to verify trade or industry experience for a Career and Technical Education field or Computer Science field.	CTEX2000 (rev. 03/2023)
HTSB Form RA4010: Verification of Experience for Renewal 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.	RA4010 (rev. 12/2022)
HTSB Form RA5010 T: Documentation of Meeting HTSB Teacher Performance Standards for License Renewal 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.	RA5010 T (rev. 12/2021)
HTSB Form RA5010 C: *Documentation of Meeting HTSB School Counselor Performance Standards for License Renewal* 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.	RA5010 C (rev. 12/2021)
HTSB Form RA5010 L: *Documentation of Meeting HTSB School Librarian Performance Standards for License Renewal* 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.	RA5010 L (rev. 12/2021)
HTSB Voluntary Removal of License Field Request Form 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 (rev. 02/2021)
HTSB Voluntary Surrender of License, Permit, or Certificate Request Form This form is used to request the voluntary 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 License (rev. 01/2022)
HTSB Form RA6010 T: *Hawaii Teacher Performance Standards Worksheet* 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 T (rev. 12/2022)
HTSB Form RA6010 C: Hawaii School Counselor Performance Standards Worksheet 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 C (rev. 12/2021)
HTSB Form RA6010 L: Hawaii School Librarian Performance Standards Worksheet 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.	RA6010 L (rev. 12/2021)
HTSB Form TL7010: Verification of Teacher Leader Experience This form is for Hawaii DOE Teacher Leaders who need their administrators to verify teacher leader experience.	TL7010 (rev. 12/2021)
HTSB Formal Notary Request Form This form is to formally request the notarization of a Hawaii License.	Formal Notary Request (rev. 03/2022)