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D.M.R.- THE MERICAN AMESUTRALITY RED WASHINGTON NURSING SERVICE APPLICATION FOR ENROLLMENT (To be filled out entirely in applicant's handwriting and each question answered fully) 2. 1. Address Name of applicant in full, Street in full. Bishapis Harriette Hame Dhllday Duyalas close (mg Dr. 423. Date of birth ang not 10Th 1875 4. Are you married, single or a widow? Single Place of birth newy ask City.,My Are you a citizen of the United States? yes 5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no Are you physically strong and healthy? ylo 6. Name educational institutions attended before entering training school, stating number of years at each and from which you were graduated him Jasemms myc miss rather MHC Aamah home Academy md until about 12 younded 9 finishes about 7. What languages other than English do you speak? zluch 9. From what hospital training school did you receive your diplo ma? Ranswell Hospital HMC hy 8. Occupation before entering training school hnng O.R. City and state Date of graduation march 1901 10. Character of hospital: General? yes Private? 12. number of patients in hospitals during training 2389 456 with Length of course. a Thru years 11. Did your training include obstetrics? yes Care of men? heo Children? yes Contagious diseases? no Special? Samuel Daily average 44 superintendent Granvenor apto. montrol anderson Canada him many Alexanide Name and address of of training school under whom you received training Hospital 14. your Training Sthod hear 99 months misternity Arapitality If training as a nurse was receive more than one hospital, give name, location and time spent in each 15. Of what nursing organizations are you a member? Roment Ampital Alumnai an (3mrs, if is affiliated with the American Nurses Association? Ravenell Anthotal Almmer the 16. 17) Which, Give name any, and address of secretary of at least one of these organizations. Baramelt Ampital Alassmune and Play mrs 2.7 hifthenes 255 h 95th Dr. my C 18. Are you a registered nurse? yes In what state? hemly Date of registration June. 29th,905 19. State how, where and for what period of time, in each instance, you have been employed since graduation, including present employment, giving name and address of persons in charge Printe mirror for 8 years Aane not fallnood my propersism Dince 1909. (Specify for which of the following services you wish to be considered.) 20. War service, wherever needed U.S. only When available Are you willing to take the oath of allegiance? 21. Instructor, Elementary Hygiene Home Dietetics Surgical Dressings 22. Health in Public Name and permanent Nursing address Town of and nearest Country relative Nursing Rh Service Rev Alfred A anding DD. 23. Buhy A Lestimation The Brihars Drug Cathedan close Indivistan Date December 19. 1917. Signature Harriette Iheldan Daughts 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, and A. R. C. 150. 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 and 11, should be forwarded to the Chairman, National Committee on Nursing Service, 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 Com- mittee, from whence credentials will be procured. REQ. 17-876-May 20M

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Page context
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    "ocrText": "D.M.R.-\nTHE MERICAN AMESUTRALITY RED\nWASHINGTON\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n2. 1. Address Name of applicant in full, Street in full. Bishapis Harriette Hame Dhllday Duyalas close (mg Dr.\n423. Date of birth ang not 10Th 1875\n4. Are you married, single or a widow?\nSingle\nPlace of birth newy ask City.,My\nAre you a citizen of the United States? yes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno\nAre you physically strong and healthy?\nylo\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nwere graduated him Jasemms myc miss rather MHC Aamah home Academy\nmd until about 12 younded 9 finishes about\n7. What languages other than English do you speak?\nzluch\n9. From what hospital training school did you receive your diplo ma? Ranswell Hospital HMC hy\n8. Occupation before entering training school\nhnng\nO.R.\nCity and state\nDate of graduation march 1901\n10. Character of hospital: General?\nyes\nPrivate?\n12. number of patients in hospitals during training 2389 456 with Length of course. a Thru years\n11. Did your training include obstetrics? yes Care of men? heo Children? yes Contagious diseases? no\nSpecial?\nSamuel Daily average 44 superintendent Granvenor apto. montrol anderson Canada him many Alexanide\nName and address of of training school under whom you received training\nHospital 14. your Training Sthod hear 99 months misternity Arapitality\nIf training as a nurse was receive more than one hospital, give name, location and time spent in each\n15. Of what nursing organizations are you a member?\nRoment Ampital Alumnai an (3mrs,\nif is affiliated with the American Nurses Association? Ravenell Anthotal Almmer the\n16. 17) Which, Give name any, and address of secretary of at least one of these organizations. Baramelt Ampital Alassmune and\nPlay mrs 2.7 hifthenes 255 h 95th Dr. my C\n18. Are you a registered nurse? yes\nIn what state? hemly Date of registration\nJune. 29th,905\n19.\nState how, where and for what period of time, in each instance, you have been employed since graduation, including present\nemployment, giving name and address of persons in charge Printe mirror for 8 years\nAane not fallnood my propersism Dince 1909.\n(Specify for which of the following services you wish to be considered.)\n20. War service, wherever needed\nU.S. only\nWhen available\nAre you willing to take the oath of allegiance?\n21. Instructor, Elementary Hygiene\nHome Dietetics\nSurgical Dressings\n22. Health in\nPublic Name and permanent Nursing address Town of and nearest Country relative Nursing Rh Service Rev Alfred A anding DD.\n23. Buhy A Lestimation The Brihars Drug Cathedan close Indivistan\nDate December 19. 1917.\nSignature Harriette Iheldan Daughts\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, and A. R. C. 150.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorsement\nby Local Committee, with credentials (Forms 3 and 4) together with Forms 10 and 11, should be forwarded to the Chairman,\nNational Committee on Nursing Service, American Red Cross, Washington, D. C.\nIn\ncase the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local\nCommittee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-\nmittee, from whence credentials will be procured.\nREQ. 17-876-May 20M"
}