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[Ed. Form, No. 3.]
TEACHER'S MONTHLY SCHOOL REPORT
For the Month of June [[crossed out]] July [[/crossed out]], 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.

[Answers placed here.]
Name of your School? Brook road School.   
Location (town, county, or district)? Henrico Co.  
Is it a Day or Night School? day School   
Of what grade? Mixed
When did your present session commence? July 1st   
When to close? I dont know
Is your School supported by an Educational Society? yes   
What Society? New York friends
Is your School supported wholly by local School Board?* no   
Name of Board or Com.?   
Am't pd. this month? 
Is your School supported in part by local School Board?* no   
Name of Board or Com.?   
Am't pd. this month? 
Is your School supported wholly by Freedmen? no   
Amount paid this month? Ten dollars. 
Is your School supported in part by Freedmen? yes   
Amount paid this month? 
Have you had Bureau transportation this term? 
Who owns the School-building? Mr S Bayly 
Is rent paid by Freedmen's Bureau? yes   
How much per month? 8 dollars
What number of Teachers and Assistants in your School? 1   
White? 
Colored? Colored
Total enrolment for the month?† 45   
Male? 27  
Female? 18
Number enrolled last report? none  

{Number enrolled last report, by adding new scholars and subtracting those left school, must equal the present total enrolment.}

Number left school this month? one 
Number new Scholars this month? all
What is the average attendance? 20

{Schools are to be kept five days per week and six hours each day.}

How many hours have you taught per day? 6 
How many days have you taught this month? 21 
{Give reasons for deficiency of time, (if any,) in teaching.}

Number of Pupils for whom tuition is paid?  
Number of White Pupils? none
Number always present? 3
Number always punctual? none
Number over 16 years of age? 14 
Number in Alphabet? 3
Number who spell, and read easy lessons? 34 
Number in advanced readers? 11
Number in Geography? 5
Number in Arithmetic? 12
Number in higher branches? 4 
Number in Writing? 9
Number in Needle-work? none 
Number free before the war? one 
Have you a Sabbath-School? yes   
How many Teachers? one   
How many Pupils? 45 
Have you an Industrial School? yes   
How many Teachers?   
How many Pupils? 
State the kind of work done? farmmers 

☞ To the following questions give exact or approximate answers, prefixing to the latter the word "about."
1. Do you know of any Schools for Refugees or Freedmen not reported to the State Superintendent?   
How many? 
2. Give (estimated) whole number of pupils in all such Schools?   
No. of Teachers, 
White, 
Colored, 
3. Do you know of Sabbath Schools not reported to the State Superintendent?   
How many? 
4. Give (estimated) whole number of pupils in all such Schools?   
No. of Teachers, 
White, 
Colored, 
5. State the public sentiment towards Colored Schools, 
6. How many pupils in your School are members of a Temperance Society?   
Name of the Society? 
Remarks. 

(Signed) Henry Bacon 
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.