APP!.ICATION FOR LOCAL PERMIT
PART I
(To be fiilled in by applicant)
l.
Name
I Mr.
M&J6
*rederlck $cott
i MfrT
.A,Crlan
te of birth
April
I
white
Negro--
1-0, t9??
Note: Write name in full. Married women. will write narne as follows: Mrs. Mary Henderson Hicks
(Mrs. Robert M. Hicks).
2.
3.
$. King St.o
LeesFurgt
Virgilla
_
ltlgh Schoot
Name of high school,attended and periocl of attend.anc.. Leeshrg
permanent
address
h03
.
19LA i19L4-''
Jrreo
of graduation from this school
rnstitute
Vir
o
4.
5.
Give length of teaching experience, and name and location of last
6.
Show year of last teaching experience in
7.
Virginia - - -
Name of last certifi.cate held, with date
of
school. None
_
19L5
19&lr
-
19h5
-
,,
Virginia
expiration
Out-of -State
B. Your name exactly as it appeared on this certificate
g. Last year in which a Virginia Local Permit was held
C^'&*;/Z
.../, fu-,*;"',
Signature of Applicant
,t
PART II
(To be filled in by the Division Superintendent)
Teacher
Where and for what purpose is applicant to be used? Be specific
gradE$ and p,rLncipal
of iil]*lsboro Elanentarlf
County
$f $fu*h and seventh
School.
orxttrxt(
Llry
Ioudoun
Signed
Date
tctober
Division Superintendent
3
p-51
(The Superintendent and applicant should fill out
n"*:ri#d
3 in duplicate. Pages 2 and 4 are
for the Department
(This page is for the use of the State Board of Education only)
COMMONWEALTH OF VIRGINIA
STATE BOARD OF EDUCATION
LOCAL PERMIT
FNEDEBIEK SOOTT
This Local Permit is issued to authorize the employment of
1
for the
Date of
r--..-
1
to
July 1.
AMIAI{
-ffi
L956 tn
aB90
TOUDOUN
County
Oetobcr 7^ 1515
State Superintend,ent
o
Any change, erasure, or
mutilation of this license will
render it null and void.
!\Coordinator
Instruction
OSll$ e".rrlnEd,ucation
Not valid without the seal of tte State Board of Education
thLs loc*l, Pmfits tu hcncby qtcuded for the sehooL gorllon'L956-57...7/3a/56..
This IocAL PERurr is hereby scbended for the school session L?ST-10...9/Lj/j7