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[ED. FORM, No. 4.]
TEACHER'S MONTHLY SCHOOL REPORT,
For the Month of February 1867.

☞ A School under the distinct control of one Teacher, or a Teacher with one assistant, is to be reported as one School.
☞ To be forwarded as soon as possible after the 1st of each month.

Number of Day-Schools... 1.
Number of Night-Schools... 1.
Location, and Name of School...at Colored Orphans "Home."
When opened...February 1st
Societies &c.. Patrons...Bangor F.A. Association
Number of Schools sustained by freedmen... 0 
Number of Schools sustained in part by freedmen... 0 
Number of teachers transported by Bureau... 0 
Number of School buildings owned by freedmen... 0 
Number of School buildings furnished by Bureau... 1.
Whole number of teachers... 1...White...Colored...
Whole number of pupils enrolled....70...Male.39...Female.31...
Numbers of pupils enrolled last report... 70. 
Number left school this month...0.
Number of new scholars this month...0.
Average attendance...15.8/70
Number of pupils paying tuition...0 
Number of White pupils...0 
Number always present...49. 
Number always punctual...48 
Number over 16 years of age...0
Number in Alphabet...8 
Number who spell and read easy lessons...27 
Number of advanced readers...10.
Number in geography...6.
Number in arithmetic...8.
Number in higher branches...4.
Number in writing...30 
Number on needlework...30 
Number free before the war...
Number of Sabbath Schools...[[strikethrough]] 70 [[/strikethrough]] 1
Number of pupils in Sabbath Schools...70.

To these questions give exact, or approximate answers. 
1. How many of above Schools are graded?... How many grades?...
2. How many Day or Night Schools, within your knowledge, not reported above?...Number of pupils (estimated) in such Schools?...
3. How many Teachers in the above Day or Night Schools?...White,...Colored,...
4. How many Sabbath-Schools, within your knowledge, and not reported above?...Number of pupils (estimated) in such Schools?...
5. How many Teachers in the above Sabbath-Schools?...White,...Colored,...
6. How many Industrial Schools?...Whole number of pupils in all?...State the kind of work done,...
7. Whole amount of tuition paid by the Freedmen during the month,...
8. Whole amount of cost of transportation furnished by the Bureau for the month,...
9. Grand total of expense per month for support of above schools by all parties,...
10. Whole number of High or Normal Schools,...How many pupils in all?...
11. Remarks... All absent from school were sick or left for homes at the north. The eleven who went north, were in school from one to two days only, this month.

☞ This Report is incomplete unless each blank is filled by a number, or cypher.

Transcription Notes:
Not sure if "Average Attendance" is supposed to be 15.8/70 but that's what I saw and wrote.