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a K M at NURSING SERVICE. My APPLICATION FOR ENROLIMENT. to (To be filled out entirely in applicant's handwriting and each question answered fully). 1. Name of applicant in full marie Therese 2. Address in full, Street 12 London State. Eng. 3. Date of birth. may Co. 1881 Place of birth: new you !. City 4. Are you married, single or a widow? married Are you a citizen of the United States? Untilmariagett Ganada 5. Have you any physical defects or tendency to costitutional or pulmonary trouble no Are you physically strong and healthy? yes. 6. Name educational institutions attended before entering training school, stating number of years at each &c from which you were graduated Grammar School 54.7446 8grs graduated Hadleigh. High gratuly Covers. Gradiary signatic graduated 7. languages English you What other than do speak? Studied drease his German Nonother 8. Occupation before entering training school none for evently 9. From hospital training you receive your what school did diploma French n.y.Coty. City and state nest 34th Street Date of Traduation Capital 4.1.191! 10. Character of hospital: General? General Special: Private? 11. Did your training include obstetrics? yes Care of men?. yes. Children? yes Contagious diseases? yes. 12. Daily average number of patients in hospitals during training. 130 Length of course. 2. y.s. if 13. Name and address of superintendent of training school under whom you received training. miss m. 1.1.: london clew your Hospital mest 6.5th St neid family 14. If your training as a nurse was received in more than one, hospital give name, location and time spent in h Hospital 24m S loane Hosticalton women 3mos manhattand E.g. 6.wands 15. Of what nursing organizations are you a member? none 5 16. Which, if any, is affiliated with the American Nurses Association? 4 17. Give name and address of secretary of at least one of these organiza- W tions 3

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    "ocrText": "a\nK\nM\nat\nNURSING SERVICE.\nMy\nAPPLICATION FOR ENROLIMENT.\nto\n(To be filled out entirely in applicant's handwriting and each\nquestion answered fully).\n1. Name of applicant in full marie Therese\n2. Address in full, Street 12 London State. Eng.\n3. Date of birth. may Co. 1881\nPlace of birth: new you !. City\n4. Are you married, single or a widow?\nmarried\nAre you a citizen of the United States? Untilmariagett Ganada\n5. Have you any physical defects or tendency to\ncostitutional or pulmonary trouble\nno\nAre you physically strong and healthy?\nyes.\n6. Name educational institutions attended before entering training school,\nstating number of years at each &c from which you were graduated\nGrammar School 54.7446 8grs graduated\nHadleigh. High gratuly Covers. Gradiary signatic graduated\n7. languages English you\nWhat other than do speak? Studied drease his German\nNonother\n8. Occupation before entering training school\nnone for evently\n9. From hospital training you receive your\nwhat school did diploma French\nn.y.Coty. City and state nest 34th Street Date\nof\nTraduation Capital 4.1.191!\n10. Character of hospital: General? General\nSpecial:\nPrivate?\n11. Did your training include obstetrics? yes\nCare of men?. yes.\nChildren?\nyes\nContagious diseases? yes.\n12. Daily average number of patients in hospitals during training. 130\nLength of course. 2. y.s. if\n13. Name and address of superintendent of training school under whom you\nreceived training. miss m. 1.1.: london\nclew your Hospital mest 6.5th St neid family\n14. If your training as a nurse was received in more than one, hospital\ngive name, location and time spent in h Hospital 24m\nS loane Hosticalton women 3mos manhattand E.g. 6.wands\n15. Of what nursing organizations are you a member? none\n5\n16. Which, if any, is affiliated with the American Nurses Association?\n4\n17. Give name and address of secretary of at least one of these organiza-\nW\ntions\n3"
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