DOE OTM 700-001
Last Revised: 08/01/2018
DEPARTMENT OF EDUCATION
Office of Talent Management
EQ Section
P.O. Box 2360 Honolulu, HI 96804
Name: ______________________________________________________________ Employee ID: ________________________
Email: ___________________________________
School/Office: __________________________
II. HQ DESIGNATION INFORMATION
Check the grade span for which HQ designation is sought:
PK-K
PK-3 K-6 6-8 6-12
K-12
Are you currently licensed in Hawaii to teach at these grade levels?
No Do not complete this form. Contact HTSB for licensing requirements
Check ONE (1) subject in which you are currently assigned and seeking HQ designation:
Art
Elementary
Elementary Special Education
Check here if you have (select only one (1)):
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
Earned a major in the content area or thirty (30) semester credits in the content area
- Complete "HQ Content Area Course Identification" form (DOE OTM 700-003) AND attach official transcripts.
For teachers with an "effective" or better teacher performance rating and earned thirty (30) semester credits in areas of
elementary curriculum
- Complete "HQ Content Area Course Identification" form (DOE OTM 700-003) AND attach official transcripts.
For teachers with an "effective" or better teacher performance rating and earned seventy-five (75) points through the
ESSA
Rubric
III. EMPLOYEE AND SCHOOL CERTIFICATION
Teacher Signature: ________________________________________
Date: _______________________
Principal Signature: ________________________________________ Date: _______________________
HQ DOCUMENTATION COVERSHEET
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 hidoeotm.org/eq.
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.
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 OTM, EQ Section.
Distribution: 1. Original - OTM, EQ Section; 2. Copy 1 - School; 3. Copy 2 - Employee
Other:______________________
- Complete "ESSA Rubric" (DOE OTM 700-002) and submit relevant documentation.
English/Language Arts
Mathematics
Science
CTE:___________________
Foreign Language:________________________
Social Studies:___________________________
