HTSB Forms

The Hawai’i Teacher Standards Board (HTSB) uses the additional required forms to determine whether an applicant has met the licensure, permit, and certification requirements. HTSB requires the submittal of official documents for all applications prior to issuing a license, permit, or certificate (read HTSB’s New Business Item 22-23 policy).

Completed forms should be uploaded using the Documents tab in your HTSB account.
If a form is incomplete, difficult to read, or not scanned in its entirety, an HTSB staff member will request that you resubmit a clear and complete version.
Your first and last name listed in your HTSB profile MUST match the name on all forms and documents submitted. If there has been a name change, please submit a name change request and upload the required documentation to support the name change.
Have the correct out-of-state licensing agency and/or educator preparation program fill out the required parts of your form(s). Note that there is a difference between an Educator Preparation Program and an out-of-state licensing agency.
Forms received with errors can delay the review process. Please note that the review process can take up to six weeks or longer to complete. This can include, but is not limited to, waiting for additional information from external agencies or schools.

The additional forms listed below are needed for select HTSB license and permit applications and are categorized as follows:

Initial Forms

OS3009: Licensing Agency Confirmation of Licensure
To verify a license from another U.S. state. This includes professional educator licenses issued by other U.S. states and U.S. territories of Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico. The other jurisdiction may also verify basic skills and content knowledge on this form. HTSB Form: [⇩ PDF] OS3009 (rev. 07/2025)

LA3009: Out-of-State Institutional Recommendation

To verify completion of a state-approved teacher education program (SATEP) not based in Hawaiʻi. This includes programs based in other U.S. states, the District of Columbia, and the U.S. territories of Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico. Applications from individuals who completed an out-of-state program must be accompanied by a copy of a valid, unrevoked license/certificate/credential from another jurisdiction. Individuals who completed a Hawaiʻi program do not need to submit this form, as their program will be verified electronically by the Hawaiʻi SATEP.

HTSB Form: [⇩ PDF] LA3009 (rev. 09/2022)

**NOTE: Effective immediately, see Board-adopted requirements for any individual seeking a Hawaiʻi license who has completed an out-of-state program and has not acquired a full license or certificate from a U.S. state, the District of Columbia, or a U.S. territory. All documentation is required to support the LA3009.

EX1000: Verification of Employment

To verify experience to qualify for a Standard or Advanced License, or to Add a Field to a license. Hawaiʻi Department of Education teachers do not need to submit this form, as their experience will be verified electronically by HIDOE.

HTSB Form: [⇩ PDF] EX1000 (rev. 09/2022)

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

OT8010: Verification of Online Teaching Experience and Content Knowledge

To verify both teaching experience and content knowledge in order to add the field of Online Teaching to an active/valid Standard or Advanced License.

HTSB Form: [⇩ PDF] OT8010 (rev. 02/2024)

CTEX2000: Recommendation and Verification for Career and Technical Education (CTE) Special Permit

To verify CTE qualifications and experience. The CTE Special Permit also requires a request from a Hawaiʻi Department of Education school administrator and an approved recommendation from the Superintendent or their Designee.

HTSB Form: [⇩ PDF] CTEX2000 (rev. 12/31/2025)

Add a Teaching Field Forms

AF8010: Add-a-Teaching Field Coursework Credit Worksheet

Applicants should refer to their official transcript(s) to determine if they have 30 credits in the content area of the new license field they wish to add. Of the 30 credits, 15 must be upper-division credits (i.e., 300 or higher). All credits must be completed at a regionally accredited institution.

HTSB Form: [⇩ PDF] AF8010 (rev. 02/2024)

LA3009: Out-of-State Institutional Recommendation

To verify completion of a state-approved teacher education program (SATEP) not based in Hawaiʻi. This includes programs based in other U.S. states, the District of Columbia, and the U.S. territories of Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico. Applications from individuals who completed an out-of-state program must be accompanied by a copy of a valid, unrevoked license/certificate/credential from another jurisdiction. Individuals who completed a Hawaiʻi program do not need to submit this form, as their program will be verified electronically by the Hawaiʻi SATEP.

HTSB Form: [⇩ PDF] LA3009 (rev. 09/2022)

**NOTE: Effective immediately, see Board-adopted requirements for any individual seeking a Hawaiʻi license who has completed an out-of-state program and has not acquired a full license or certificate from a U.S. state, the District of Columbia, or a U.S. territory. All documentation is required to support the LA3009.

EX1000: Verification of Employment

To verify experience to qualify for a Standard or Advanced License, or to Add a Field to a license. Hawaiʻi Department of Education teachers do not need to submit this form, as their experience will be verified electronically by HIDOE.

HTSB Form: [⇩ PDF] EX1000 (rev. 09/2022)

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

OT8010: Verification of Online Teaching Experience and Content Knowledge

To verify both teaching experience and content knowledge in order to add the field of Online Teaching to an active/valid Standard or Advanced License.

HTSB Form: [⇩ PDF] OT8010 (rev. 02/2024)

TL7010: Verification of Teacher Leader Experience

For Hawaiʻi Department of Education Teacher Leaders who need their administrators to verify teacher leader experience.

HTSB Form: [⇩ PDF] TL7010 (rev. 12/2021)

License Renewal Forms

These additional forms are needed for HTSB’s Standard and Advanced License renewal applications ONLY.

RA4010: Verification of Experience for License Renewal

For non-Hawaiʻi Department of Education teachers to verify employment for license renewal. HIDOE teachers will have their experience verified electronically.

HTSB Form: [⇩ PDF] RA4010 (rev. 12/2022)

RA5010 T: Documentation of Meeting HTSB Teacher Performance Standards for License Renewal

Verification of satisfying Hawaiʻi Teacher Performance Standards. This form helps applicants record how they verify that they meet the teaching standards. Hawaiʻi Department of Education teachers who received a satisfactory evaluation during the term for which they are renewing their license will be verified electronically by HIDOE.

Each piece of evidence uploaded MUST CLEARLY IDENTIFY the specific standard and performance indicator it corresponds to. Failure to properly label the evidence will result in the submission being returned to the applicant for proper identification. Additionally, the application will be placed on hold until the required labeling is provided. It is imperative to comply with these requirements to avoid delays or interruptions in the application review process.

HTSB Form: [⇩ PDF] RA5010 T (rev. 12/2021)

RA5010 C: Documentation of Meeting HTSB School Counselor Performance Standards for License Renewal

Verification of satisfying Hawaiʻi Counselor Performance Standards. This form helps applicants record how they verify that they meet the counseling standards. Hawaiʻi Department of Education counselors who had a satisfactory evaluation during the term of the license they are renewing will be verified electronically by HIDOE.

Each piece of evidence uploaded MUST CLEARLY IDENTIFY the specific standard and performance indicator it corresponds to. Failure to properly label the evidence will result in the submission being returned to the applicant for proper identification. Additionally, the application will be placed on hold until the required labeling is provided. It is imperative to comply with these requirements to avoid delays or interruptions in the application review process.

HTSB Form: [⇩ PDF] RA5010 C (rev. 12/2021)

RA5010 L: Documentation of Meeting HTSB School Librarian Performance Standards for License Renewal

Verification of satisfying Hawaiʻi Librarian Performance Standards. This form helps applicants record how they verify that they meet the librarian standards. Hawaiʻi Department of Education librarians who had a satisfactory evaluation during the term of the license they are renewing will be verified electronically by HIDOE.

Each piece of evidence uploaded MUST CLEARLY IDENTIFY the specific standard and performance indicator it corresponds to. Failure to properly label the evidence will result in the submission being returned to the applicant for proper identification. Additionally, the application will be placed on hold until the required labeling is provided. It is imperative to comply with these requirements to avoid delays or interruptions in the application review process.

HTSB Form: [⇩ PDF] RA5010 L (rev. 12/2021)

RA6010 T: Hawaiʻi Teacher Performance Standards Worksheet

For non-Hawaiʻi Department of Education teachers, their administrators must verify that they meet the Hawaiʻi Teacher Performance Standards on their most recent evaluation. This form is a worksheet designed to accompany the most recent teacher evaluation.

HTSB Form: [⇩ PDF] RA6010 T (rev. 12/2022)

RA6010 C: Hawaiʻi School Counselor Performance Standards Worksheet

For non-Hawaiʻi Department of Education school counselors, their administrators must verify that they meet the Hawaiʻi Teacher Performance Standards on their most recent evaluation. This form is a worksheet designed to accompany the most recent teacher evaluation.

HTSB Form: [⇩ PDF] RA6010 C (rev. 12/2021)

RA6010 L: Hawaiʻi School Librarian Performance Standards Worksheet

For non-Hawaiʻi Department of Education school librarians, their administrators must verify that they meet the Hawaiʻi Teacher Performance Standards on their most recent evaluation. This form is a worksheet designed to accompany the most recent teacher evaluation.

HTSB Form: [⇩ PDF] RA6010 L (rev. 12/2021)

Other Forms (Voluntary Removal, Voluntary Surrender, and Notary Request)

Voluntary Removal of License Field Request Form

To request that a license field be removed from an active license. Once removed, a license field can only be added to an active license if the requirements in effect at that time are met.

HTSB Form: [⇩ PDF] Request to Remove License Field (rev. 02/2021)

Voluntary Surrender of License, Permit, or Certificate Request Form

To request the voluntary surrender of an active teaching license, permit, or certificate for a variety of reasons. Please ensure that you complete all fields on the form.

HTSB Form: [⇩ PDF] Request to Surrender License (rev. 01/2022)

Formal Notary Request Form

To formally request the notarization of a Hawaiʻi license.

HTSB Form: [⇩ PDF] Formal Notary Request (rev. 03/2022)