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L I - - is D Amy M rs The Ameriran Thed Urnas NEW YORK STATE BRANCH 3 D Application for General Nursing Service 5 1. Namei in full: any may Hilliard. R.N. I 2. Becket Name: Henry Hilliand Address: Dansvill. MB Telephone No.: Jackson Ran- M. 4. Friend or Address: 5% Kenmon ave., newark. n.J. 5. Age. 36 6. Are you a citizen of the U. S.1 l am 7. Of what training school for Nurses are you a graduate? st. Luhi's J.S.n., newy rhcity 8. Date of graduation. July 1903 9. Are you registered in New York State? l am. 10. Of what Nursing Organizations are you a member? n.4. state nurnes aim through sta St. Luhis Hope alumnn arin Give name and address of the following officers: Name: sanhel L. Ivans (smote) Pres. Address: 35 East 67th ft. nee Name: mrs. Hug haR Jush Sec'y. Address: 909 ave H. John mys. 11. Do you enroll for paid or volunteer nursing service in the Red Cross? volinteer 12. What experience have you had since graduation, in private, in- stitutional or district nursing; in sanitary inspection, in epi- demics, and in investigation for giving discriminate relief? supervisor op. rooms Presby, Trap. chicago. 3 years. ask. supp. nurn kruce Hope Detroit. 4 mo. supt. minus (abour address 2% years

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    "ocrText": "L\nI - -\nis\nD\nAmy\nM\nrs\nThe Ameriran Thed Urnas\nNEW YORK STATE BRANCH\n3\nD\nApplication for General Nursing Service\n5\n1.\nNamei in full: any may Hilliard. R.N.\nI\n2.\nBecket Name: Henry Hilliand\nAddress: Dansvill. MB Telephone No.: Jackson Ran-\nM.\n4.\nFriend or Address: 5% Kenmon ave., newark. n.J.\n5. Age.\n36 6. Are you a citizen of the U. S.1 l am\n7.\nOf what training school for Nurses are you a graduate?\nst. Luhi's J.S.n., newy rhcity\n8. Date of graduation. July 1903\n9. Are you registered in New York State? l am.\n10. Of what Nursing Organizations are you a member? n.4.\nstate nurnes aim through sta St.\nLuhis Hope alumnn arin\nGive name and address of the following officers:\nName: sanhel L. Ivans (smote)\nPres.\nAddress:\n35 East 67th ft. nee\nName: mrs. Hug haR Jush\nSec'y.\nAddress: 909 ave H. John mys.\n11. Do you enroll for paid or volunteer nursing service in the Red\nCross? volinteer\n12. What experience have you had since graduation, in private, in-\nstitutional or district nursing; in sanitary inspection, in epi-\ndemics, and in investigation for giving discriminate relief?\nsupervisor op. rooms Presby, Trap. chicago. 3 years.\nask. supp. nurn kruce Hope Detroit. 4 mo.\nsupt. minus (abour address\n2% years"
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