JOSH GREEN, M.D.
GOVERNOR
KEITH T. HAYASHI
SUPERINTENDENT
STATE OF HAWAI‘I
DEPARTMENT OF EDUCATION
KA ‘OIHANA HO‘ONA‘AUAO
BOX 2360
HONOLULU, HAWAI‘I 96804
LICENSE RENEWAL APPLICATION 2023 - 2025
Private Trade, Vocational or Technical (PTVT) School License renewal applications are
processed every two years during odd-numbered years (i.e. 2021, 2023, etc.). License
renewals are due this year (2023) which will be valid from September 1, 2023 to August 31,
2025.
✔ Deadline: July 3, 2023
✔ Filing Fee: $2000.00 (To Hawaii Department of Education)
A change in ownership requires the submission of an Initial License Application.
THINGS TO KNOW ABOUT
1. Review Hawaii Administrative Rules, Title 8, Chapter 101, Licensing of Private,
Trade, Vocational or Technical Schools.
All schools and staff must comply with the Hawaii Administrative Rules, Title 8,
Chapter 101. A licensed school shall make available a copy of this chapter to
members of the staff and students upon request.
2. GI Bill: If you currently or plan to accept students who are eligible to use the GI Bill,
contact the Hawaii State Approving Agency if you have not done so yet.
Tel: 808-369-3559 or Email: [email protected].
➢ DOCUMENTS TO PROVIDE:
Accreditation or Board Affiliation:
Provide a copy of a current letter or document showing that the school is accredited
by an accrediting commission of career schools and colleges, accrediting council for
continuing education and training, or an accrediting bureau of health education
schools; provided that in lieu of such accreditation, the school may provide a letter
from the relevant state,federal, or other licensing authority demonstrating that the
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 1
LICENSE RENEWAL APPLICATION
For Private Trade, Vocational, or Technical
Schools Hawaii Department of Education
License Application for 2023-2025
private trade, vocational, or technical school's curriculum is sufficient to prepare a
graduate to qualify for employment.
Massage Therapy Schools Only: Massage therapy schools must obtain a current
letter of approval from the local massage board. Please fill the application form and
send it to the Hawaii Board of Massage Therapy. Upon receiving your approval
letter, please provide a copy with your renewal material.
Current Business Registration: Please provide a copy of your current business
registration.
Surety Bond (Affidavit): Submit a current copy of a Surety Bond. Bond
amount is $50,000.00. Requests for a bond reduction must be accompanied by
reasonable justification and documentation.
License Renewal Fee: Submit License Renewal Fee of $2,000.00 payable to
the Hawaii Department of Education. Hawaii Revised Statutes, Section 40-35.5,
Assessment and collection of service charges for dishonored payments, requires
all DOE schools and offices receiving revenues or other monies on behalf of the
State to assess and collect a service charge in the amount of $25.00 for any
remittance for payment that is dishonored for any reason.
Current Catalog: Please provide a catalog reflecting your 2023 programs.
Location: If your location has changed or will later, please provide:
County Building Department inspection (which includes the maximum occupant
load)
Fire Inspection
Floor Plan
➢ FORMS TO FILL: Please fill out the following forms which apply.
● New Principal (Skip if no new principal)
● New instructors (Skip if no new instructors)
● Summary of Returning Instructors
● Annual Summary of Courses, Fees and Enrollment
● Annual Summary of Fiscal Operations
● Certification of Applicant and Agreement for Student Transcripts
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 2
PRINCIPAL CERTIFICATION FORM
License Application for 2023-2025
(Skip to next page if no new principal)
Complete this section and attach the following:
❏ Documentation of Training and Experience
❏ Three (3) Letters of Verification testifying to the character, ability, and competency to operate the
school as proposed
A. PERSONAL INFORMATION
Legal Name (Last, First, Middle)
Social Security Number
xxx-xx-
Mailing Address
Phone Number
E-mail Address
Name of School
B. CERTIFICATION
I certify that I have adequate training and experience to be principal of the school.
As principal of the school, I shall be responsible for:
❏ Complying with all applicable State, County, and Department of Education policies.
❏ Providing reports and information as required by the Department of Education.
❏ Informing the Department of Education of changes in school policies, programs, facilities,
tuition, calendar, and all other matters affecting the status of the school as originally licensed.
❏ Providing all advertisements, recruitment procedures employed by representatives of the
school, published materials, and public relations activities.
❏ Directing and supervising the school’s staff and program.
❏ Assuring that all facilities comply with State and City and County requirements.
Signature of Principal
Date
C. OWNER VERIFICATION AND ASSURANCE
The above individual will serve as principal of the school. Evidence of the following is attached:
❏ Documentation of Training and Experience
❏ Three (3) Letters of Verification testifying to the character, ability, and competency to operate
the school as proposed
I shall comply with all applicable State, County, and Department of Education policies.
Signature of Owner
Date
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 3
APPLICATION FOR NEW INSTRUCTOR
License Application for 2023 - 2025
(Skip to Section K if no new instructors)
Complete this section for each new instructor and attach the following:
❏ Evidence that a standard learning period has been completed and passed for the trade or vocation
noted (i.e., resume, transcripts, diploma/certificate)
❏ Employment verification of a minimum of 5,400 hours (approximately three (3) years) of work
experience for the trade or vocation noted
❏ Current Hawaii licenses for the trade or vocation noted if required of instructors by law or ordinance
❏ Current and valid tuberculosis clearance certificate
D. PERSONAL INFORMATION
Legal Name (Last, First, Middle)
Social Security Number
xxx-xx-
Mailing Address
Phone Number
E-mail Address
Trade/Vocation Certification Areas
E. EDUCATIONAL AND PROFESSIONAL TRAINING
Area of Study
or Major
From
(mm/yy)
To
(mm/yy)
Certificates
Diplomas
Degrees
Award
Date
(mm/yy)
F. TEACHING EXPERIENCE (if none leave blank)
Discipline or Area Taught
From
(mm/yy)
To
(mm/yy)
Years
Months
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 4
APPLICATION FOR NEW INSTRUCTOR
License Application for 2023-2025
G. WORK EXPERIENCE OTHER THAN TEACHING
Nature of Work
From
(mm/yy)
To
(mm/yy)
Years
Months
H. APPLICANT CERTIFICATION STATEMENT
I certify that the foregoing information in Sections A, B, C, and D are correct to the best of my
knowledge. I have also attached the required documents.
Signature of Applicant
Date
I. ASSURANCES BY THE PRINCIPAL
All documents necessary to apply for the Professional Staff Certificate (PSC) are attached. I have
reviewed and verified the applicant’s training, background, and experience. The applicant is qualified to
serve as an instructor and a member of my teaching faculty.
Name of School
Signature of Principal
Date
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 5
LIST OF NEW INSTRUCTORS
License Application for 2023-2025
❏ List all new instructors in alphabetical order. Provide additional pages if necessary.
❏ Non-Instructional staff members must submit a current and valid tuberculosis (TB)
clearance certificate
J. NEW INSTRUCTIONAL STAFF (Skip to Section K if no new instructors)
Legal Name (Last, First, Middle)
Last Four Social Security Number
Course(s) Taught
Individual Licensure
Individual Licensure
K. NON-INSTRUCTIONAL STAFF (Attach TB clearance certificate)
Legal Name (Last, First, Middle)
Position
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 6
Legal Name (Last, First, Middle)
Last Four Social Security Number
Course(s) Taught
Legal Name (Last, First, Middle)
Last Four Social Security Number
Course(s) Taught
Legal Name (Last, First, Middle)
Last Four Social Security Number
Course(s) Taught
Board
License Number
Expiration Date
Board
License Number
Expiration Date
Board
License Number
Expiration Date
Board
License Number
Expiration Date
Individual Licensure
Individual Licensure
SUMMARY OF CURRENT INSTRUCTORS FORM
License Application for 2023-2025
L. RETURNING INSTRUCTIONAL STAFF (Must have Application for Professional Staff Certificate on file)
Legal Name (Last, First, Middle)
Teacher Certificate No.
M. PRINCIPAL’S SIGNATURE
Name of School
Total Number of Staff
Signature of Principal
Date
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 7
ANNUAL SUMMARY OF COURSES, FEES, AND ENROLLMENT
License Application for 2023-2025
Instructions
❏ Submit one sheet for each vocation/trade
❏ Include all Federal, State, and Private reimbursements for each class in the appropriate area (i.e. tuition, books, etc.)
N. SCHOOL INFORMATION
School
School Year to
Vocation/Trade
Signature of Principal
Date
O. COURSE LOG AND INFORMATION
Course Title
Fees
Total Length of Course
Number of Students
Tuition
Registration
Books/Supplies
Other (List)
Days/Sessions
Weeks
Credit/Clock Hours
Enrolled
Graduated/Completed
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 8
ANNUAL SUMMARY OF FISCAL OPERATIONS
License Application for 2023-2025
Instructions
❏ Complete this form
❏ Attach a copy of the most recent Financial Report (audited/unaudited report)
P. SCHOOL INFORMATION
Name of School
Signature of Principal
Date
Q. INCOME AND EXPENDITURES
INCOME
EXPENDITURES
Registration
$
Salaries
$
Student Tuition
$
Rent
$
Federal Reimbursement
$
Instructional Materials
$
State Reimbursement
$
Furniture
$
Private Reimbursement
$
Utilities
$
Books/Supplies
$
Office Supplies
$
Other Fees (List)
Other Expenses (List)
TOTAL
$
TOTAL
$
R. NET PROFIT/LOSS
Subtract income total from expenditure total
$
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 9
LICENSE RENEWAL APPLICATION
For Private Trade, Vocational, or Technical
Schools Hawaii Department of Education
License Application for 2023-2025
CERTIFICATION OF APPLICANT
By submitting this licensing application, I hereby attest that I have reviewed the contents
for accuracy. All forms submitted are in compliance with Hawaii Administrative Rules,
Title 8, Chapter 101. In addition, I certify the adherence to provisions of the Hawaii
Revised Statutes Sections 302A-424 to 302A-428.
STUDENT TRANSCRIPT AGREEMENT
By signing this form, you are also agreeing to turn over student transcripts to the Hawaii
Department of Education upon permanent school closure as stated in Title 8, Chapter
101. Transcripts can be in electronic or paper format.
Signature of Authorized Officer: Date:
Print Name: Title:
Please mail application material to:
State of Hawaii, Department of Education
Office of Curriculum and Instructional Design
Private Trade, Vocational or Technical Schools
475 22nd Avenue, Room 205 Honolulu, HI 96816
You may also send by email to: [email protected]
For questions, please call: (808)-305-9764 or email: [email protected]
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 10
LICENSE RENEWAL APPLICATION
For Private Trade, Vocational, or Technical Schools
Hawaii Department of Education
License Application for 2023-2025
Contact Information
Fire Safety Requirements
City and County of Honolulu - Fire Department
Fire Prevention Bureau
636 South Street
Honolulu, Hawaii 96813-5007
Phone: 723-7161
Web site: http://www.honolulu.gov/hfd
Safety and Building Code Compliance
City and County of Honolulu - Department of Planning and Permitting
Building Division
650 South King Street
Honolulu Hawaii 96813
Phone: (808) 768-8000
Email: [email protected]
Web site: www.honoluludpp.org
Hawaii State Department of Labor and Industrial Relations
Occupational Safety and Health Division - Consultation and Training Branch 830
Punchbowl Street, Room 423
Honolulu, Hawaii 96813
Phone: 586-9100
Email: [email protected]
Web site: http://labor.hawaii.gov/hiosh/
Hawaii State Department of Health
Disability and Communication Access
Board 919 Ala Moana Blvd., Room 101
Honolulu, Hawaii 96814
Phone: 586-8121
Email: [email protected]
Web site: https://health.hawaii.gov/dcab/
Hawaii Department of Education
Private Trade, Vocational or Technical Schools 11