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FORM 1037
REV. FEB. 1941
AMERICAN RED CROSS NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out in applicant's handwriting and each question answered fully)
1. Name of applicant in full Heurietta Sophia Fitch
If married, give maiden name
2. Permanent address
75 Grove (Street) St, montelain (City) Esses, (County) new Jersey (State)
3. Probable address for one year 75 (Street) Grove St., montelair (City) Essex, (County) new versey.
4. Name and permanent address of nearest relative or friend residing in the United States:
mis w.g. Spelling (Name) 75 Since (Address) St. montclai (Relationship) aunt
5. Race
6. Present Marital Status
7. Citizenship
8. What languages other than English do you
speak?
White
Single
Native born
None
German
Negro
Married
Naturalized
Spanish
Scandinavian
Other
Widowed
Non citizen
French
Polish
Divorced
Italian
Other
Catholic Sister
9. Date of birth aug. 20, 1909 Place of birth new york City Is United Father States? a citizen of
the
Yes
No
10. General education (prior to entering nursing):
Did you graduate from high school
Yes
No
If no, how many years of high school do you lack? I yrs.
What college or university education did you have prior to entering nursing?
None or less
1 year;
2 years;
3 years;
Bachelors
Masters
PH.D.
than 1 year;
Degree;
Degree;
11. Nursing Education:
a. School of nursing from which
graduated mountainside (Name) Hospital montclai, (City) (State)
Date of graduation September 19. 30
Length
of
course:
5 years;
3 years;
(Specify Other)
b. Undergraduate affiliations:
Clinical
Hospital or Organization
City and State
specialty
No. months
(3) (2) (1) ng State mental Ind n.g Contagious Psychiatry
Willard Parker Hoop
3
3
c. Postgraduate clinical courses (Do not include academic work or employment)
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
(3)
d. Academic study since graduation from School of Nursing:
College or University
City and State
Number of full time
Number of
academic years
points
(1)
(2)
(3)
e. Check all degrees obtained
Bachelors
Masters
PH. D.
Certificate in Public Health
subsequent to entering training:
Degree;
Degree;
Nursing
f. In which major field was your academic study?
Institutional
Public Health
Non nursing (specify)
Other (specify)
(Over)
Page data
- Page
- 83
- Source index
- 0
- Type
- photo
- Media ID
- a0df4a5f03268696
- Size
- unknown
Document data
- ID
- 2661469
- Core
- doc
- Type
- document
DTO data
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"ocrText": "FORM 1037\nREV. FEB. 1941\nAMERICAN RED CROSS NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out in applicant's handwriting and each question answered fully)\n1. Name of applicant in full Heurietta Sophia Fitch\nIf married, give maiden name\n2. Permanent address\n75 Grove (Street) St, montelain (City) Esses, (County) new Jersey (State)\n3. Probable address for one year 75 (Street) Grove St., montelair (City) Essex, (County) new versey.\n4. Name and permanent address of nearest relative or friend residing in the United States:\nmis w.g. Spelling (Name) 75 Since (Address) St. montclai (Relationship) aunt\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nspeak?\nWhite\nSingle\nNative born\nNone\nGerman\nNegro\nMarried\nNaturalized\nSpanish\nScandinavian\nOther\nWidowed\nNon citizen\nFrench\nPolish\nDivorced\nItalian\nOther\nCatholic Sister\n9. Date of birth aug. 20, 1909 Place of birth new york City Is United Father States? a citizen of\nthe\nYes\nNo\n10. General education (prior to entering nursing):\nDid you graduate from high school\nYes\nNo\nIf no, how many years of high school do you lack? I yrs.\nWhat college or university education did you have prior to entering nursing?\nNone or less\n1 year;\n2 years;\n3 years;\nBachelors\nMasters\nPH.D.\nthan 1 year;\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\ngraduated mountainside (Name) Hospital montclai, (City) (State)\nDate of graduation September 19. 30\nLength\nof\ncourse:\n5 years;\n3 years;\n(Specify Other)\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(3) (2) (1) ng State mental Ind n.g Contagious Psychiatry\nWillard Parker Hoop\n3\n3\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nd. Academic study since graduation from School of Nursing:\nCollege or University\nCity and State\nNumber of full time\nNumber of\nacademic years\npoints\n(1)\n(2)\n(3)\ne. Check all degrees obtained\nBachelors\nMasters\nPH. D.\nCertificate in Public Health\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\nInstitutional\nPublic Health\nNon nursing (specify)\nOther (specify)\n(Over)"
}