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Y
plain
FORM 1219
REV. AUG. 1941
Date Auth
AMERICAN RED CROSS
Return to Miss Dunbar
Type of Auth
Nursing Service
Chapter
APPLICATION FORM
State
SERVICE IN HAWAII
W-66P!
WRUNGWOWA WWURSEN
Confidential
and
NURSING
Please return
I. PERSONAL
Date January 30,1942
Name in full Miss Heurietta Sophia Fitchedge
(No. 94017
(H.D
(MISS OR MRS)
(IF MARRIED GIVE MAIDEN NAME)
Not enrolled
Present address 75 (STREET) Grove St monthain, (CITY) of (STATE)
Tel. 78.2-8348M.
Permanent address 29 (STREET) O enforch St. (CITY) montchair (STATE) inf
mo
Tel. No. 2-3217.
Date of birth aug 20, 1909
Marital status
Single
(SINGLE. MARRIED. WIDOWED. DIVORCED)
Race White
Citizenship
American
II. EDUCATION
1. Prior to entering school of nursing
Diploma
Name
City and State Dates
or Degree
Major
High School Lakeville. nova Scation Sauada
1915-26.
Normal School
or University
Other
2. School of nursing from which you graduated
Name Location (CITY AND STATE) Hospital Date of graduation 1930 Length of course 3 yrs
monstering
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
Theyatone Wiflard Park Parker Hospital, Hospital Maria new york Family City Contagrop mental
3 months
3 months
4. Academic study since graduation from school of nursing
College or University or
Diploma
postgraduate course
City and State No Months or Degree
Major
What courses in principles of teaching have you had?
Have you had a course in practice teaching? no
Do you hold a state teacher's certificate?
no
Where
Do you speak a foreign language? THE
no
(Over)
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"ocrText": "For Office Use Only\nY\nplain\nFORM 1219\nREV. AUG. 1941\nDate Auth\nAMERICAN RED CROSS\nReturn to Miss Dunbar\nType of Auth\nNursing Service\nChapter\nAPPLICATION FORM\nState\nSERVICE IN HAWAII\nW-66P!\nWRUNGWOWA WWURSEN\nConfidential\nand\nNURSING\nPlease return\nI. PERSONAL\nDate January 30,1942\nName in full Miss Heurietta Sophia Fitchedge\n(No. 94017\n(H.D\n(MISS OR MRS)\n(IF MARRIED GIVE MAIDEN NAME)\nNot enrolled\nPresent address 75 (STREET) Grove St monthain, (CITY) of (STATE)\nTel. 78.2-8348M.\nPermanent address 29 (STREET) O enforch St. (CITY) montchair (STATE) inf\nmo\nTel. No. 2-3217.\nDate of birth aug 20, 1909\nMarital status\nSingle\n(SINGLE. MARRIED. WIDOWED. DIVORCED)\nRace White\nCitizenship\nAmerican\nII. EDUCATION\n1. Prior to entering school of nursing\nDiploma\nName\nCity and State Dates\nor Degree\nMajor\nHigh School Lakeville. nova Scation Sauada\n1915-26.\nNormal School\nor University\nOther\n2. School of nursing from which you graduated\nName Location (CITY AND STATE) Hospital Date of graduation 1930 Length of course 3 yrs\nmonstering\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\nTheyatone Wiflard Park Parker Hospital, Hospital Maria new york Family City Contagrop mental\n3 months\n3 months\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\npostgraduate course\nCity and State No Months or Degree\nMajor\nWhat courses in principles of teaching have you had?\nHave you had a course in practice teaching? no\nDo you hold a state teacher's certificate?\nno\nWhere\nDo you speak a foreign language? THE\nno\n(Over)"
}