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D. M.R.-1
THE AMERUTRALITY SOOS
MERICAN RED
ASHINGTON
D
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting and each question answered fully)
1. Name of applicant in full Carberine Stuart Mover
2. Address in full, Street 16.1 w 61st
City new York
State new.York
N
by
3. Date of birth 7uq 2. 1885
Place of birth Canada
4. Are or widow?
you married, single it! Single
Are you a citizen of the United States? no
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
us
Are you physically strong and healthy?
Yes
6. Name educational institutions attended before entering training school, stating number of years at each and from which you
were graduated
Prives St. School -Including from 9yes
Charlottetown Business College - 2yrs
7. What languages other than English do you speak?
ume
h.8. Occupation before entering training school
Home
9. From what hospital training school did you receive your diploma?
the Children Hospital
City and state
Botton massachusetts
Date of graduation May, 19.6
10. Character of hospital: General?
Special?
Yes
Private?
11. Did your training include obstetrics? Two
Care of men? Yes Children? Yes Contagious diseases? no
12. Daily average number of patients in hospitals during training
180
Length of course
3yes
13. Name and address of superintendent of training school under whom you received training
miss Elegebeth Sullivan 300 fay wood are Bostin new
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
massachusetls general Hospital 4 nutes
15. Of what nursing organizations are you a member?
Alumnie Association Children's Hospital
16.
Which,
if
any,
is
affiliated
with the American Nurses Association? Children's Hospital alumon asso
17.
Give name and address of secretary of at least one of these organizations mus Pluly Sayle
new run Centre mass
18. Are you a registered nurse?
Yes
In what state? moss
Date of registration aug 9. 1917
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
from many 5 to Sept 1 1916 Head nurse and second theirge
at the children's Hospital Boston moo
from Sept to presen time Head nurse
the Seduative
Service all the new ynk Therseng a child Hospital
(Specify for which of the following services you wish to be considered.)
20. War service, wherever needed foreign
U.S. only
When available after not 1st
Are you willing to take the oath of allegiance?
yes
21. Instructor, Elementary Hygiene
Home Dietetics
Surgical Dressings
22. Public Health Nursing in Town and Country Nursing Service
23. Name and permanent address of nearest relative
Dr. many Dover
neomith Sl. Sowell men
Date aug 1917
Signature
Carthorine So Doren
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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"ocrText": "D. M.R.-1\nTHE AMERUTRALITY SOOS\nMERICAN RED\nASHINGTON\nD\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1. Name of applicant in full Carberine Stuart Mover\n2. Address in full, Street 16.1 w 61st\nCity new York\nState new.York\nN\nby\n3. Date of birth 7uq 2. 1885\nPlace of birth Canada\n4. Are or widow?\nyou married, single it! Single\nAre you a citizen of the United States? no\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nus\nAre you physically strong and healthy?\nYes\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nwere graduated\nPrives St. School -Including from 9yes\nCharlottetown Business College - 2yrs\n7. What languages other than English do you speak?\nume\nh.8. Occupation before entering training school\nHome\n9. From what hospital training school did you receive your diploma?\nthe Children Hospital\nCity and state\nBotton massachusetts\nDate of graduation May, 19.6\n10. Character of hospital: General?\nSpecial?\nYes\nPrivate?\n11. Did your training include obstetrics? Two\nCare of men? Yes Children? Yes Contagious diseases? no\n12. Daily average number of patients in hospitals during training\n180\nLength of course\n3yes\n13. Name and address of superintendent of training school under whom you received training\nmiss Elegebeth Sullivan 300 fay wood are Bostin new\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nmassachusetls general Hospital 4 nutes\n15. Of what nursing organizations are you a member?\nAlumnie Association Children's Hospital\n16.\nWhich,\nif\nany,\nis\naffiliated\nwith the American Nurses Association? Children's Hospital alumon asso\n17.\nGive name and address of secretary of at least one of these organizations mus Pluly Sayle\nnew run Centre mass\n18. Are you a registered nurse?\nYes\nIn what state? moss\nDate of registration aug 9. 1917\n19. State 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\nfrom many 5 to Sept 1 1916 Head nurse and second theirge\nat the children's Hospital Boston moo\nfrom Sept to presen time Head nurse\nthe Seduative\nService all the new ynk Therseng a child Hospital\n(Specify for which of the following services you wish to be considered.)\n20. War service, wherever needed foreign\nU.S. only\nWhen available after not 1st\nAre you willing to take the oath of allegiance?\nyes\n21. Instructor, Elementary Hygiene\nHome Dietetics\nSurgical Dressings\n22. Public Health Nursing in Town and Country Nursing Service\n23. Name and permanent address of nearest relative\nDr. many Dover\nneomith Sl. Sowell men\nDate aug 1917\nSignature\nCarthorine So Doren\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 case 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"
}