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[ED. FORM NO. 4]

TEACHER'S MONTHLY
SCHOOL REPORT
For month of November 1867
[[Strikethrough]] District or County, [[/Strikethrough]] Washington, D.C.
State, District of Columbia
Name of School, No 5 Intermediate 3rd Dist
Name of Teacher, Mrs. E. W. Clark
Public School
X

Forwarded
Received  X

[[Right Margin]] EXPLANATIONS
The accompanying Blank is a copy of the Bureau Superintendent's Blank placed in columnar form for the sake of simplicity and to preserve uniformity.
It is hoped that the Educational Associations will adopt this blank, or one which will contain these questions. (Should this exact form be adopted the Bureau can furnish the blanks.)
If any question cannot be answered by the teacher, it may be left for the Superintendent. Place each answer, to the extent of your knowledge, opposite the question, and he will fill the remaining spaces.
It is supposed that no teacher has more than one day and one night school, or but one of either.
Night and Sabbath schools taught by a group of teachers should be reported but once.
The above explanations are deemed necessary where this blank is adopted by the Associations.
Should more extended forms be used, it would oblige the Commissioner to have them include all the items of this.
BUREAU R.F.&A.L., Washington, D.C., Oct. 1, 1866. [[/Right Margin]]