COMMONWEALTH OF VIRGINIA
DEPARTMENT OF EDUCATION
P. O. BOX 2120
RICHMOND, VIRGINIA 23218-2120
SUPTS. MEMO. NO. 35
May 31, 1996

ADMINISTRATIVE

TO: Division Superintendents
FROM: William C. Bosher, Jr.
Superintendent of Public Instruction
SUBJECT: Forms for the 1996-97 School Session

 
  Enclosed is a requisition to facilitate your request for
  certain forms that are furnished by the Department of
  Education for use in your schools during the 1996-97 school
  year.  The completed requisition should be mailed in time to
  arrive on or before June 30, 1996, to:
  
               Mr. Howard D. Ruffner
               Warehouse Manager
               Department of Education
               P. O. Box 2120
               Richmond, Virginia  23218-2120
  
  Should you have any questions, please contact Mr. Ruffner at
  (804) 786-2835.
  
  
  
  WCBJr/pfm
  
  Enclosure:   A copy of this memo and its attachment will
               be sent to the superintendent's office
    BBA.023
  
      USE THIS FORM TO ORDER ONLY THE ITEMS LISTED BELOW
  
  
                                             _______________
                                                 Date
  
               VIRGINIA DEPARTMENT OF EDUCATION
                REQUISITION FOR CERTAIN FORMS
  
  
  DEC-1   Driver Education Certificate                 _____
  HPE-h9  Virginia Physical Inspection of Students     _____
  HPE-h12 School Entrance Health Information Form      _____
  LE.005  Cumulative Physical Fitness Record           _____
  LF.012a Summary of Physical Fitness Ratings          _____
          Teacher's Report to Principal (Revised 1990)
  LF.009  Cumulative Health Record                     _____
  LF.010  Summary of Physical Defects and Corrections  _____
          (Teacher/Nurse Report to Principal)
  LF.011  Summary of Physical Defects and Corrections  _____
          (Principal's Report to Division Superintendent)
  PA No.1 Principal's Record of Attendance             _____
  PA No.2 Principal's Monthly Report to Superintendent _____
          (25 Sets Per Pad)                            pads
  PA No.3 Principal's Summary of Monthly Reports       _____
  S-2     Principal's Term Report                      _____
  T-25    Teacher's Register                           _____
  SNP-12  Daily Record of Operation (Revised 1995)     _____
          (20 Sheets Per Pad - One Per School)
  A.C.020 Food Production Records                      _____
          (100 Sheets Per Pad)                         pads
  
  MCH-213C School Entrance Physical Examination and     _____
          Immunization Certification Health Form
  
    BBA.023                                              Page Two
  
  
  
          (When ordering School Food Service Brochures, 
          please order by whole package)
  
          School Food Is Good ...  Brochure            _____
          (250 per package)                            pkg.
  
          Tell Me About School Meals:  Answer for      _____
          Parents ... Brochure (250 per package)       pkg.
  
          We Are Pleased To Provide Meals for School   _____
          Personnel ... Brochure                       pkg.
          (250 per package)
  
          Get In Step With Breakfast ... Brochure      _____
          (50 per package)                             pkg.
  
  
  
  
         ___________________________________________
  
  
  
  Contact Person:        ___________________________________
                         Signature, Division Superintendent
  
  _____________________  ___________________________________
     Printed Name             County, Town, or City
  
  
  _____________________  ___________________________________
     Telephone Number         Address (Street Address if
                                       possible)
  
                         ___________________________________
                              City and Zip Code