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[Ed. Form, No. 3]
TEACHER'S MONTHLY
SCHOOL REPORT
For the month of June, 186 .
District or County, Henrico
State, Virginia
Name of School, Hotel
Name of Teacher, A. A. Clark

Forwarded
Received


EXPLANATIONS
If any of the within questions cannot be answered by the teacher, they 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. 
Night and Sabbath schools taught by a group of teachers should be reported but once.
In the "Remarks" notice any important facts which the blank does not call for.
It is hoped that the Educational Societies will adopt this form of Report; if so, the Bureau can furnish the blanks. 
☞Should more extended forms be used, it would oblige the Commissioner to have them include all items of this.
BUREAU R., F., & A.L., Washington, D.C., Jan. 1, 1868.

Transcription Notes:
There is a town called Henrico in Virginia, so I belive that is what is in the Ditrict or county field here. The name of the school I believe is Hotel, due to taking a look at the next page (which has the actual report from this school, which definitely says the school is Union Hotel). Also the signature on the next page is from Adela A Clark, so I believe the Name of teacher field is A A. Clark here (also the A is not quite the same as her H in Hotel).