COMMONWEALTH OF VIRGINIA
DEPARTMENT OF EDUCATION
P. O. BOX 2120
RICHMOND, VIRGINIA 23218-2120
SUPTS. MEMO. NO. 25
May 29, 1998

ADMINISTRATIVE

TO: Division Superintendents
FROM: Paul D. Stapleton
Superintendent of Public Instruction
SUBJECT: Forms for the 1998-99 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 1998-99 school
  year.  The completed requisition should be mailed in time to
  arrive on or before June 30, 1998, 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.



  PDS/fyt

  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


  HPE-h9  Virginia Physical Inspection of Students           _____
  LE.005  Cumulative Wellness Related Fitness Record         _____
  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       pads
          (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 1/2 x 11(100 Sheets Per Pad)                     pads

  A.C.020 Food Production Records                            _____
          8 1/2 X 14 (100 Sheets per Pad)                    pads                 

  MCH-213C     School Entrance Physical Examination and      _____     
               Immunization Certification Health Form


  (When ordering School Food Service Brochures, please order 
  by whole package)


     ___________________________________________



  Contact Person:        _____________________________________
                          Signature, Division Superintendent


  _____________________  _____________________________________
      Printed Name              County, Town, or City


  _____________________  ____________________________________
   Telephone Number      Address (Street Address if possible)


                         _____________________________________
                                   City and Zip Code