COMMONWEALTH OF VIRGINIA
DEPARTMENT OF EDUCATION
P. O. BOX 2120
RICHMOND, VIRGINIA 23218-2120

SUPTS. MEMO. NO. 40
June 6, 1997

ADMINISTRATIVE

TO: Division Superintendents
FROM: Richard T. La Pointe
Superintendent of Public Instruction
SUBJECT: Forms for the 1997-98 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 1997-98 school
  year.  The completed requisition should be mailed in time to
  arrive on or before June 30, 1997, 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.



  RTL/pfm

  Enclosure:   A hard copy of this memo and its enclosure
               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                      _____
          8+ x 11 (100 Sheets Per Pad)                 pads
  A.C.020 Food Production Records                      _____
          8+ x 14 (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)






         ___________________________________________



  Contact Person:        _____________________________________
                         Signature, Division Superintendent


  ________________________    ___________________________________
     Printed Name             County, Town, or City


  ________________________    _____________________________________
     Telephone Number         Address (Street Address if possible)


                              ________________________________
                              City and Zip Code