Verification of Experience for Renewal (RA 4010) - Hawai?i ... - htsb-2026

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The document is the HTSB Form RA 4010, a verification form used by applicants to renew their Hawai`i teaching license. It requires the applicant to provide personal information and authorize the release of their teaching experience details. An authorized school or district official must complete a section confirming the applicant's qualifying teaching experience within the last five years.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section 1, Personal Information. Enter your Social Security Number, full name (last, first, middle), date of birth, current mailing address, and contact numbers. Ensure you use blue ink if printing.
Sign the Disclaimer in Section 1 to authorize the release of your teaching experience information. This signature is crucial before sending the form to an authorized official.
Retain a copy of this form for your records after completing it.
Section 2 will be completed by an authorized school or district official. Ensure they understand their role in verifying your teaching experience as outlined.

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