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[Ed. Form, No.3.]
___

TEACHER’S MONTHLY 
SCHOOL REPORT

For the month of Dec, 1869
District or County, County of Chesterfield 
State, of Virginia
Name of School, Midlothian
Name of Teacher, J M Taylor 

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 exact 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 fact 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 the items of this. 
BUREAU R.,F., AND A.L., Washington, D.C., October 1, 1868.

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