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[Ed. Form, No. 3.]
Teachers' Monthly School Report
For the Month of December, 1869.
-To contain one entire calendar month, and to be forwarded as soon as possible after the close of the month.
-A School under the distinct control of one Teacher, or a Teacher with one Assistant, is to be reported as one School.

Name of your School?
Is it a Day or Night-School?
When did your present session commence?
Is your School supported by an Educational Society?
Is your School supported wholly by local School Board?*
Is your School supported in part by local School Board?*
Is your School supported wholly by Freedmen?
Is your School supported in part by Freedmen?
Have you had Bureau transportation this term?
Who owns the School-Building?
Is rent paid by the Freedmen's Bureau?
What number of Teachers and Assistants in your School?
Total enrollment for the month?+
Number enrolled last report?
Number left school this month?
Number new Scholars this month?
What is the average attendance?
Number of Pupils for whom tuition is paid?
Number of White Pupils?
Number always present?
Number always punctual?
Number over 16 years of age? 
Number in Alphabet?
Number who spell, and read easy lessons?
Number in advanced readers?
Number in Geography?
Number in Arithmetic?
Number in higher branches?
Number in Writing?
Number in Needle-work?
Number free before the war?
Have you a Sabbath-School?
Have you an Industrial School?
State the kind of work done?

[Answers placed here?]
Burley Location (town, county, or district)? Harrisburg 
Day Of what grade? Primary and Intermediate 
Oct 23 When to close? December 24th 
Last What Society? American Missionary Association 
No Name of Board or Com.? 0 Am't pd. this month? 0
No Name of Board or Com.? 0 Am't pd. this month? 0
No Amount paid this month? 0
Yes Amount paid this month? $30.44
Freedmen
Yes How much per month? $6.00
1 White? 1 Colored? 0
15 Male? 15 Female? 30
17 {Number enrolled last report, by adding new scholars and subtracting those left school, must equal the present total enrollment.}
1
14
35 {Schools are to be kept five days per week and six hours each day.}
24
0 How many hours have you taught per day? 6
11 How many days have you taught this month? 21
4
5 {Give reasons for deficiency of time, (if any) in teaching.}
11
22
12
8
13
0
6
0
0
Yes How many Teachers? 3 How many Pupils? 89
No How many Teachers? 0 How many Pupils? 0
None

To the following questions give exact or approximate answers, preferring to the latter the word "about."
1. Do you know of any Schools for Refugees or Freedmen not reported to the State Superintendent? No How many? 0
2. Give (estimated) whole number of pupils in all such Schools? 0 No. of Teachers. 0 White, 0 Colored, 0
3. Do you know of Sabbath Schools not reported to the State Superintendent? No How many? 0
4. Give (estimated) whole number of pupils in all such Schools? 0 No. of Teachers, 0 White, 0 Colored, 0
5. State the public sentiment towards Colored Schools, Favorable
6. How many pupils in your School are members of a Temperance Society? 0 Name of the Society? No sec'y
Remarks. The want of desks still makes a deficiency in the writing department.
(Signed) Martha E. Green,
Teacher.

*Or School Committee, either District, Town, City, County, or State?
+A pupil is not to be reported as enrolled until after five days'attendance.