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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)

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83
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0
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photo
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Page context
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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)"
}