Hq Documentation Coversheet - Hawaii State Department Of Education
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1DOE OHR 700-001
Last Revised: 07/01/2013
Former DOE Form(s): Doc. 2a
HQ DOCUMENTATION COVERSHEET
DEPARTMENT OF EDUCATION
Office of Human Resources
HQT Section
P.O. Box 2360 Honolulu, HI 96804
I. EMPLOYEE INFORMATION
Name: ______________________________________________________________
Employee ID: ________________________
Last
First
M.I.
Tel#: _________________
School/Office: __________________________
Email: ___________________________________
II. HQ DESIGNATION INFORMATION
Check the grade span for which HQ designation is sought:
PK-K
K-12
PK-3
K-6
6-8
6-12
Are you currently licensed in Hawaii to teach at these grade levels?
Yes
No. Do not complete this form. Contact HTSB for licensing requirements and complete HQ Professional
Development Plan at https://pde3.k12.hi.us.
Check ONE (1) subject in which you are currently assigned and seeking HQ designation:
Art
Elementary
Foreign Language
Mathematics
Civics/Government
Elementary Special Education
Geography
Science
Economics
English/Language Arts
History
one (1)):
Check here if you have (select only
A current National Board Certification in the content area (except MC Generalist for middle school teachers)
- Attach a copy of certificate
Passed the designated PRAXIS II in the content area
- Attach a copy of PRAXIS examinee score report
Been deemed highly qualified in the content area in another state
- Complete "Out of State Highly Qualified Teacher Verification Form" (DOE OHR 700-005).
- Indicate the state and date form DOE OHR 700-005 was mailed:_______________________________________________
Earned a major in the content area or thirty (30) semester credits in the content area
- Complete "Core Content Area Course Identification" form (DOE OHR 700-003) AND attach official transcripts.
For teachers with the equivalent of one (1) or more academic years of experience and earned thirty (30) semester credits in areas of
elementary curriculum
- Complete "Core Content Area Course Identification" form (DOE OHR 700-003) AND attach official transcripts.
For teachers with equivalent of one (1) or more academic years of experience and earned one hundred (100) points through HOUSSE
- Complete "HOUSSE Form" (DOE OHR 700-002) and submit relevant documentation
Final HQT status is determined by DOE upon verification of the information submitted/indicated on this form and
supporting documentation. Final approval will be reflected on
III. EMPLOYEE AND SCHOOL CERTIFICATION
By signing this statement, I certify that I have accurately reported the information herein. I understand that misrepresentation or
falsification of information supplied on this form may result in sanctions including termination from employment and/or professional
discipline. I agree to retain copies of all documentation related to HQ designation for future reference by the Hawaii DOE.
Teacher Signature: ________________________________________
Date: _______________________
MM/DD/YYYY
VERIFICATION BY SCHOOL OFFICIAL: By signing this statement, I certify that I have reviewed all attached documentation and
validated that the information herein is correctly reported. I agree to retain copies of all documentation related to HQ designation in the
teacher’s yellow jacket for review during periodic Title II monitoring and to forward this documentation to any DOE school to which
this teacher may transfer. I also certify that I have furnished the original of this form to the DOE OHR, HQT Section.
Principal Signature: ________________________________________
Date: _______________________
MM/DD/YYYY
Distribution: 1. Original - OHR, HQT Section; 2. Copy 1 - School; 3. Copy 2 - Employee
(Page 1 of 1)
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