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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
2871,
NURSING SERVICES
MILITARY SERIAL NUMBER
&
9
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
IF MARRIED, GIVE MAIDEN NAME
Foerster, Alma Emma HUSBAND'S
Badger 2017.
D
NAME
-
PERMANENT ADDRESS (Street, city, zone, county, state)
5946 N.E. Circle Ave., Chicago 31, Illinois
{
PRESENT ADDRESS (Street, city, zone, county, state)
U.S.Veterans Administration, Mendota, Wis,
a
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Mvs. John 1 F. Dreyer. sister- Permanent Address about
sister,
DATE OF BIRTH (Month, day, year)
Single
Married
Separated
Jidowed
Divorced
July 25,1885
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
English and German,
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
New YorkCity, N.4. 1925-1927 Junes Bachelor
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
Wisconsing Illinois
NURSES' ASSOCIATION? through Clume
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst. staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
staff
Psychiatric
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
visiveterans Adminis tration,
Mendota, wis,
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
Good,
7
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to
participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able
to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
madison, Dane co., Wis,
1. Teach home
YES
NO
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
NO
only in home community
Attend disaster institutes, if
YES
NO
YES
In other communities
offered, in preparation for service
of disaster
4. Accept membership on chapter com-
YES
NO
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
NO
mittee should services be needed
programs, as needed
aide classes
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE
Present MAJOR REASONS position - in Hosfital-oundity - v.s. Veterans admosts. mendotar
DATE
S IGNATURE
October 1,445.
alma E, Foester, P.N., B.S.
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS
IN
KEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
C
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
Dane County Nurse Recruitment Committee
NURSE RECRUITMENT
315 N. Carroll St.
11/2/15
COMMITTEE
Madison, Wis.
FORM 1045 Rev. July 1945
78504M
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"ocrText": "Fl\nare\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n2871,\nNURSING SERVICES\nMILITARY SERIAL NUMBER\n&\n9\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF MARRIED, GIVE MAIDEN NAME\nFoerster, Alma Emma HUSBAND'S\nBadger 2017.\nD\nNAME\n-\nPERMANENT ADDRESS (Street, city, zone, county, state)\n5946 N.E. Circle Ave., Chicago 31, Illinois\n{\nPRESENT ADDRESS (Street, city, zone, county, state)\nU.S.Veterans Administration, Mendota, Wis,\na\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMvs. John 1 F. Dreyer. sister- Permanent Address about\nsister,\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nJidowed\nDivorced\nJuly 25,1885\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nEnglish and German,\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nNew YorkCity, N.4. 1925-1927 Junes Bachelor\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nWisconsing Illinois\nNURSES' ASSOCIATION? through Clume\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst. staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nstaff\nPsychiatric\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nvisiveterans Adminis tration,\nMendota, wis,\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nGood,\n7\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto\nparticipate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able\nto\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nmadison, Dane co., Wis,\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nYES\nIn other communities\noffered, in preparation for service\nof disaster\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\nmittee should services be needed\nprograms, as needed\naide classes\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE\nPresent MAJOR REASONS position - in Hosfital-oundity - v.s. Veterans admosts. mendotar\nDATE\nS IGNATURE\nOctober 1,445.\nalma E, Foester, P.N., B.S.\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS\nIN\nKEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nC\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nDane County Nurse Recruitment Committee\nNURSE RECRUITMENT\n315 N. Carroll St.\n11/2/15\nCOMMITTEE\nMadison, Wis.\nFORM 1045 Rev. July 1945\n78504M"
}