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FORM NO. 1
AMERICAN RED CROSS
ere
&
-
a
NURSING SERVICE
er
1
K
APPLICATION FOR ENROLLMENT
K
(To be filled out entirely in applicant's handwriting)
a
1. Name of applicant. Kathanus macklin Badge
+th
number
2.
Address in full 37 Brownell street, staplcton, Arwbork
3. Date of birth February 23, 1882 Place of birth new York City
4. Are you married, single or a widow? single Are you a citizen of the United States? yrs
5.
Have you any physical defects or tendency to constitutional or pulmonary trouble? no
6. Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated Public school # 14, 1887to 1897,
graduate grammer deport. T 2 you academic counce
Lackards' Business Coflage Newshop 1898 graduate of steuo
graphic 7. Depart and there monthout bookkisping
Occupation before entering training school
stanographs
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
2h chrokolitan Health Joannong School for Ausses
9. Character of hospital: General yrs
Blackwells is., ny City lepoil Special no 15 1903. Private?
10. Daily average number of patients in hospital during training 400-500 Length of course 2 yrs.
11 Name and address of superintendent of training school under whom you received training
Arw York City Hospital N.V.C.
12. Of what nursing organizations are you a member ? Metropolitan Hosp Tr.
School Plusure Crutial club for Russes,
13.
Give name and address of secretary of at least one of these organizations Channe Cawford
54 R345th New State City
14.
Are you a registered nurse ? year In what state ? Accordonk Date of registration Juns 21,1912
15. State how, where and for what period of time, in each instance, you have been employed since graduation,
including present employment Private nursing form graduature
to Octoba 1904, in How Ink City Surgrous
office unore, Oct. 19 OH to buly 1910, with
J. Honau, 15 If 73 st., ney
date prints rursing During Dhay Us
5
16. In the event of war are you willing to take the oath of allegiance ?
17.
Name and permanent address of nearest relative Nicholas 8. In ackhis, (father)
2
J
27 Brown st. Staplator H EW York
x
Date Septrules 17, 1914 Signature Kathanies on acklin
This blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee
to be forwarded with "credentials" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. C.
Page data
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Document data
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- 2661420
- Core
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- Type
- document
DTO data
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"ocrText": "Z\nFORM NO. 1\nAMERICAN RED CROSS\nere\n&\n-\na\nNURSING SERVICE\ner\n1\nK\nAPPLICATION FOR ENROLLMENT\nK\n(To be filled out entirely in applicant's handwriting)\na\n1. Name of applicant. Kathanus macklin Badge\n+th\nnumber\n2.\nAddress in full 37 Brownell street, staplcton, Arwbork\n3. Date of birth February 23, 1882 Place of birth new York City\n4. Are you married, single or a widow? single Are you a citizen of the United States? yrs\n5.\nHave you any physical defects or tendency to constitutional or pulmonary trouble? no\n6. Name educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated Public school # 14, 1887to 1897,\ngraduate grammer deport. T 2 you academic counce\nLackards' Business Coflage Newshop 1898 graduate of steuo\ngraphic 7. Depart and there monthout bookkisping\nOccupation before entering training school\nstanographs\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\n2h chrokolitan Health Joannong School for Ausses\n9. Character of hospital: General yrs\nBlackwells is., ny City lepoil Special no 15 1903. Private?\n10. Daily average number of patients in hospital during training 400-500 Length of course 2 yrs.\n11 Name and address of superintendent of training school under whom you received training\nArw York City Hospital N.V.C.\n12. Of what nursing organizations are you a member ? Metropolitan Hosp Tr.\nSchool Plusure Crutial club for Russes,\n13.\nGive name and address of secretary of at least one of these organizations Channe Cawford\n54 R345th New State City\n14.\nAre you a registered nurse ? year In what state ? Accordonk Date of registration Juns 21,1912\n15. State how, where and for what period of time, in each instance, you have been employed since graduation,\nincluding present employment Private nursing form graduature\nto Octoba 1904, in How Ink City Surgrous\noffice unore, Oct. 19 OH to buly 1910, with\nJ. Honau, 15 If 73 st., ney\ndate prints rursing During Dhay Us\n5\n16. In the event of war are you willing to take the oath of allegiance ?\n17.\nName and permanent address of nearest relative Nicholas 8. In ackhis, (father)\n2\nJ\n27 Brown st. Staplator H EW York\nx\nDate Septrules 17, 1914 Signature Kathanies on acklin\nThis blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee\nto be forwarded with \"credentials\" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. C."
}