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DMR 1
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
1.
Name of applicant in full Minnie Marcha Beihume
3
2. Address
in full, Street 3 -5-01-00 ch Cuncity Pinsburk Pa
3.
34
Are Have Date you of you birth married, any June physical single defects or a 26 widow? or tendency dingle 1884 to onstitutional or Place pulmonary Are you of birth a trouble? citizen of the United yo States? yes
Home Pa
4.
5.
Are you physically strong and healthy?
6.
Name educational institutions attended before entering training school, stating number of years at each and from
yes
which you were graduated Valamanca School a
7. you
chambulain What languages other than English do speak? yes
oki
8. 9. Occupation From what before hospital entering training training school school. did you Inschool receive your diploma west until Perm willing Hospital Training
at
I
City and state Pillshing his fa
Date of graduation M my 1909
a
10. Character of hospital: General? yes
Special ?
Private?
11. Did your training include obstetrics? yes Care of men Children? Contagious diseases? yes
12.
13. superintendent of training school under whom you received training
Name Daily average and address number of of patients hospital during training Length of course 3 yes
in
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
Miss Elizabeth R end
15. Of what nursing organizations are you a member? West Perm Elumnal
16. Which, if any, is affiliated with the American Nurses Association? ?'
17.
Give name and address of secretary of at least one of these organizations Wiss overspiter day
you
West Penn Hospital
1910
18. Are you a registered nurse? yes In what state? Permis Date of registration mehic umber 964
19. How and where employed since graduation :
Give dates with months.
Name and address of employers:
Private using
2
(Specify for which of the following services you wish to be considered.
20.
War service, wherever needed yes, Horeign developed a available.
uov / st
U
u
21.
Instructor, Are you willing Elementary to take the Hygiene oath of allegiance ? yes
W
22. Public Health Nursing
In Town and Country Nursing Service
or for War Service
r
23. Name and permanent address of nearest relative
Who m J. Beihume
11 Oreland Court Warren
Date June 11 the 1918
Signature of Nurse Minnie m. Beilune his
To the Committee.
This blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, 29, and A. R. C.
703.
Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval
and endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 11 and 29, should be for-
warded to the Chairman, Department of Nursing, American Red Cross, Washington, D. C.
In case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to
the
Local
Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the
Local Committee. from whence credentials will be procured.
1M-May
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Document data
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- Core
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DTO data
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"ocrText": "DMR 1\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1.\nName of applicant in full Minnie Marcha Beihume\n3\n2. Address\nin full, Street 3 -5-01-00 ch Cuncity Pinsburk Pa\n3.\n34\nAre Have Date you of you birth married, any June physical single defects or a 26 widow? or tendency dingle 1884 to onstitutional or Place pulmonary Are you of birth a trouble? citizen of the United yo States? yes\nHome Pa\n4.\n5.\nAre you physically strong and healthy?\n6.\nName educational institutions attended before entering training school, stating number of years at each and from\nyes\nwhich you were graduated Valamanca School a\n7. you\nchambulain What languages other than English do speak? yes\noki\n8. 9. Occupation From what before hospital entering training training school school. did you Inschool receive your diploma west until Perm willing Hospital Training\nat\nI\nCity and state Pillshing his fa\nDate of graduation M my 1909\na\n10. Character of hospital: General? yes\nSpecial ?\nPrivate?\n11. Did your training include obstetrics? yes Care of men Children? Contagious diseases? yes\n12.\n13. superintendent of training school under whom you received training\nName Daily average and address number of of patients hospital during training Length of course 3 yes\nin\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nMiss Elizabeth R end\n15. Of what nursing organizations are you a member? West Perm Elumnal\n16. Which, if any, is affiliated with the American Nurses Association? ?'\n17.\nGive name and address of secretary of at least one of these organizations Wiss overspiter day\nyou\nWest Penn Hospital\n1910\n18. Are you a registered nurse? yes In what state? Permis Date of registration mehic umber 964\n19. How and where employed since graduation :\nGive dates with months.\nName and address of employers:\nPrivate using\n2\n(Specify for which of the following services you wish to be considered.\n20.\nWar service, wherever needed yes, Horeign developed a available.\nuov / st\nU\nu\n21.\nInstructor, Are you willing Elementary to take the Hygiene oath of allegiance ? yes\nW\n22. Public Health Nursing\nIn Town and Country Nursing Service\nor for War Service\nr\n23. Name and permanent address of nearest relative\nWho m J. Beihume\n11 Oreland Court Warren\nDate June 11 the 1918\nSignature of Nurse Minnie m. Beilune his\nTo the Committee.\nThis blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, 29, and A. R. C.\n703.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval\nand endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 11 and 29, should be for-\nwarded to the Chairman, Department of Nursing, American Red Cross, Washington, D. C.\nIn case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to\nthe\nLocal\nCommittee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the\nLocal Committee. from whence credentials will be procured.\n1M-May"
}