APPLICATION FOR ADMISSION
TO THE SOLDIERS' ORPHANS' SCHOOLS
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The following information was extracted
from the ANNUAL REPORT OF THE SUPERINTENDENT OF SOLDIERS' ORPHANS, FOR THE
YEAR 1880. Pages 62-68.
II. FORM OF ORPHAN SCHOOLS.
(Class No.1)
APPLICATION FOR ADMISSION.
To J. P. WICKERSHAM, Superintendent of
Destitute Orphans of Deceased Soldiers and Sailors of the State of
Pennsylvania:
I, as . . . . . . ., do hereby apply for an order for . . . . . . .
education and maintenance, in accordance with the provisions of the act,
entitled "An act authorizing the Governor to accept the donation of
the Pennsylvania Railroad Company," approved the 6th day of May,.
1864, and of the act to provide for the maintenance of the destitute
orphans of the deceased soldiers and sailors of the State, approved March
22, A.D., 1865; and on condition of the granting of said order, and in
consideration of the education and maintenance of the orphan above named,
according to the plan adopted for carrying said acts into effect, I do
hereby resign and transfer to said Superintendent, and to his successors
in office, the custody, care, and control of said orphan, for said
purpose, till . . . . arrival at the full age of sixteen years, with
the full right to put or bind . . . . out on . . . arrival at said age,
for such employment or trade, to such employer or master, and during such
term as said Superintendent shall then select, with the written assent of
said orphan and myself.
In furtherance whereof, if hereto append the following statement of facts
in relation to said orphan, with my signature and affidavit thereto:
* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . P. O.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . County, Pa.
Witness present:**
Statement.
The above named
.........................................was born on the ............day
of ................... eighteen
hundred.........................................; now resides
in..............................................common school
district,..............................county, Pa.; is the .............
of ......................... and
......................................................... is in destitute
circumstances, being dependent for support on
..............................................................................................
The father of this orphan was an actual resident of
.................................................................. in this
State, where, in the month of .........................., 186__, he
.......................................... into the
...................................... regiment
......................................... and***
.................................................................... in
the service of the United States, at
........................................ in
......................................... on the
............................ day of ..........................., 186__,
being then in rank a
............................................................................
The said father was of the
.......................................................... denomination in
religion, and the subscriber accordingly desires that his orphan shall be
trained up in the same creed and observances.
*.....................................................................................................................
......................................................................................................Pa.,
ss:
Personally appeared before me,
................................................................................in
and for said county, the above subscribed
..............................................................., who being
duly ............................., does say that the facts set forth in
the foregoing statement are true, to the best of ......... knowledge and
belief. In testimony whereof, I have hereunto set my hand and seal,
this ................ day of
......................................................., 187__.
.....................................................................................................(SEAL)
Certificate by School Directors.
...................................................................
COMMON SCHOOL DISTRICT,
...................................................................
county, Pa.
It is hereby certified that the foregoing application and statement
were duly laid before the board of directors of the above named district,
and having been carefully examined, are found to be true and correct, so
far as the facts are known to this board. The orphan therein named
is accordingly recommended as a proper person for education and
maintenance, under the provisions of the laws on the subject.
Signed and attested, by order of the board, this .......... day of
...................... 187 .
........................................................................................................................................
President.
.......................................................................................
Secretary.
NOTE.--If the mother has re-married, this application must
be executed by a guardian.
*The mother or guardian must sign at both these places.
**Two, if mark is made.
***If the father died after being discharged, the certificate of a regular
physician, certifying under oath that, in his opinion, the father died of
a disease contracted in the service, must accompany this application.
(Class No. 2)
APPLICATION FOR ADMISSION.
TO J. P. WICKERSHAM, Superintendent of
Destitute Orphans of Deceased Soldiers and Sailors of the State of
Pennsylvania:
SIR: I, as the father of . . . . . . . . . . . . . . . . . . .
. . . . . . . ., do hereby apply for an order for . . . . . . .
education and maintenance, in accordance with the provisions of the act,
entitled "An act authorizing the Governor to accept the donation of
the Pennsylvania Railroad Company," approved the 6th day of May,.
1864, and of the act to provide for the maintenance of the destitute
orphans of the deceased soldiers and sailors of the State, approved March
22, A.D., 1865; and on condition of the granting of said order, and in
consideration of the education and maintenance of the orphan above named,
according to the plan adopted for carrying said acts into effect, I do
hereby resign and transfer to said Superintendent, and to his successors
in office, the custody, care, and control of said orphan, for said
purpose, till . . . . arrival at the full age of sixteen years, with
the full right to put or bind . . . . out on . . . arrival at said age,
for such employment or trade, to such employer or master, and during such
term as said Superintendent shall then select, with the written assent of
said orphan and myself.
In furtherance whereof, I hereto append the following statement of facts
in relation to said child, with my signature and affidavit thereto:
Witness present:**
* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . P. O.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . County, Pa.
Statement.
My son,
...............................................................................................................................
was born on the ............ day of ........................ eighteen
hundred and ...............................; he now resides with me in
.................................................................................
common school district, .............................................
county, Pennsylvania.
In consequence of
***(Here state fully the character or wounds of sickness,
and extent of disability.)
.......................................................................................................................................................................................................................
.......................................................................................................................................................................................................................
I am now in destitute circumstances and am unable to afford the said
..........................................................................................
proper education and maintenance.
I was an actual resident of
....................................................... county, in this
State, where in the month of ...........................................
186 , I enlisted into company
............................................................... regiment,
Pennsylvania volunteers, and by reason of
(Here state fully the cause of your discharge from the
service)
..........................................................................................................................................................................................................................
..........................................................................................................................................................................................................................
was honorably discharged from the service of the United States, at
.................................................................................................
on the ..........................day of
........................................... 186 , being at the
time in rank a
.........................................................................
I would further state that I am of
.......................................................................
denomination in religion, and accordingly desire that this child shall be
trained up in the same creed and observances.
*
...................................................................................................................
..........................................................................
Pa., ss:
Personally appeared before me,
.............................................................. in and for
said county, the above subscribed
..........................................................................................................
who being duly
................................................................... does
say, that the facts set forth in the foregoing statement are true to the
best of ................................................. knowledge and
belief. In testimony whereof, I have hereto set my hand and seal,
this ............................. day of
....................................... 187 .
...............................................................................................................................
(SEAL)
Physician's Certificate.
I, the undersigned, a practicing
physician in the above named common school district, hereby certify that I
have carefully examined the said
...........................................................................................................,
and find the extent of the disability as described in the foregoing
statement.
Certificate by School Directors.
..........................................................................................................................
COMMON SCHOOL DISTRICT
................................................................ County,
Pennsylvania.
It is hereby certified, that the foregoing application and statement were
duly laid before the board of directors of the above named district and
having been carefully examined, are found to the true and correct, so far
as the facts are known to this board. The child therein named is
accordingly recommended as the property person for education and
maintenance, under the provisions of the laws on the subject.
Signed and attested, by order of the board, this ................ day of
................................................, 187 .
..................................................................................................................................................,
President.
................................................................................,
Secretary.
*Sign your names at both places.
**Two, if mark is made.
***State fully the character of the sickness, the nature of the wounds, or
extent of disability.
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