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Form 1037
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Rev. 2-15-28
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1.
Name of applicant in full Martha alleying griang
2. Address in full
7034 Wise Loring Missouri
to
3. Date
of birth June 26-1984 Race White
Place of birth Missouri
+
Birthplace of father Misiouri Mother Missauri Citizenship of father american
L
5. How many years have you attended Grammar school ? 8 High school ? 4 Normal school?
4. Are you married, single or a widow ? Single Are you-a citizen of the United States ? yes
a
Private school ?
College ? If tutored privately, name subjects covered and length of time
none
D
6. What languages other than English do you speak?
7.
Occupation before entering training school Clerical those which you speak fluently)
8.
From what
City and State
Give name at time of graduation Martha I alleyne Scient
hospital St Louis training school mo did you receive Date of your graduation diploma June ? 60- 1933 Hospital
1
9.
Character of Hospital: General'
Special ?
Private?
5
11. Daily average number of patients in Hospital during training 190 Length of course. years
10. Did your training include obstetrics ayes Care of men yes Children alyes Contagious diseases' write
12.
Name and address of superintendent of nurses under whom you received training
Sister Mary lithanosis R., Sh marip of the Angele Clayton Rd+Belleaue, M.Lania,
13.
If your training as a nurse was received in more than one hospital, give name, location and time
spent in each me Rose Sanatorium, 930ys.) Broadway St. Lauis me 1 month.
14.
Are you a member of your Alumnae Association
?
yes
15.
Are you affiliated with the American Nurses Association through membership in Alumnae, Dis-
trict and State Associations ?
Affiliation with the American Nurses' Association means membership /in the District and Graduate Nurses' Associations of the
yes
state in which you are living at the present time.
16. Give name and address of secretary of at least one of these organizations
17.
Are you a registered nurse Mast In whate State ? Ms. Date of registration Number 10939
agnes Riggle 1400 You Goyala Sl Louight
18. Type of work and length of service since 'graduation:
Trivite Duty since September 1933
(Present position)
19.
Will you be willing to accept service if the United States becomes involved in war? yes
20. (a) If interested in accepting service within the near future, indicate choice; R.C.P.H. Nursing,
Instructor, Home Hygiene and care of Sick, Army, Navy, U. S. Public Health Service, U.
S. Veterans' Bureau.
(b) Date upon which you will be available for service checked
21. Are you willing to take the oath of allegiance?
any
date.
yes
22. Give name and permanent address of nearest relative or friend, residing in the United States
(state relationship)
Sunitte Tray authouth Sh Pungielle Me. mother
Date
NOTE-Norses who have had training or experience in Publie Health Nursing will, in addition to the above, fill out questions
Jan
8- 1934 Signature of nurse Martha a.g.
23 and 24 on reverse side of this blank.
To The Local Committee:
This blank is to be sent to applicant with circular letter Form 1199, together with Forms 2. 1193 and A.R.
C. 703. Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and
1193 should be forwarded to National Headquarters or to the proper Branch Office.
0
(OVER)
&
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"ocrText": "F\nForm 1037\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nRev. 2-15-28\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1.\nName of applicant in full Martha alleying griang\n2. Address in full\n7034 Wise Loring Missouri\nto\n3. Date\nof birth June 26-1984 Race White\nPlace of birth Missouri\n+\nBirthplace of father Misiouri Mother Missauri Citizenship of father american\nL\n5. How many years have you attended Grammar school ? 8 High school ? 4 Normal school?\n4. Are you married, single or a widow ? Single Are you-a citizen of the United States ? yes\na\nPrivate school ?\nCollege ? If tutored privately, name subjects covered and length of time\nnone\nD\n6. What languages other than English do you speak?\n7.\nOccupation before entering training school Clerical those which you speak fluently)\n8.\nFrom what\nCity and State\nGive name at time of graduation Martha I alleyne Scient\nhospital St Louis training school mo did you receive Date of your graduation diploma June ? 60- 1933 Hospital\n1\n9.\nCharacter of Hospital: General'\nSpecial ?\nPrivate?\n5\n11. Daily average number of patients in Hospital during training 190 Length of course. years\n10. Did your training include obstetrics ayes Care of men yes Children alyes Contagious diseases' write\n12.\nName and address of superintendent of nurses under whom you received training\nSister Mary lithanosis R., Sh marip of the Angele Clayton Rd+Belleaue, M.Lania,\n13.\nIf your training as a nurse was received in more than one hospital, give name, location and time\nspent in each me Rose Sanatorium, 930ys.) Broadway St. Lauis me 1 month.\n14.\nAre you a member of your Alumnae Association\n?\nyes\n15.\nAre you affiliated with the American Nurses Association through membership in Alumnae, Dis-\ntrict and State Associations ?\nAffiliation with the American Nurses' Association means membership /in the District and Graduate Nurses' Associations of the\nyes\nstate in which you are living at the present time.\n16. Give name and address of secretary of at least one of these organizations\n17.\nAre you a registered nurse Mast In whate State ? Ms. Date of registration Number 10939\nagnes Riggle 1400 You Goyala Sl Louight\n18. Type of work and length of service since 'graduation:\nTrivite Duty since September 1933\n(Present position)\n19.\nWill you be willing to accept service if the United States becomes involved in war? yes\n20. (a) If interested in accepting service within the near future, indicate choice; R.C.P.H. Nursing,\nInstructor, Home Hygiene and care of Sick, Army, Navy, U. S. Public Health Service, U.\nS. Veterans' Bureau.\n(b) Date upon which you will be available for service checked\n21. Are you willing to take the oath of allegiance?\nany\ndate.\nyes\n22. Give name and permanent address of nearest relative or friend, residing in the United States\n(state relationship)\nSunitte Tray authouth Sh Pungielle Me. mother\nDate\nNOTE-Norses who have had training or experience in Publie Health Nursing will, in addition to the above, fill out questions\nJan\n8- 1934 Signature of nurse Martha a.g.\n23 and 24 on reverse side of this blank.\nTo The Local Committee:\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2. 1193 and A.R.\nC. 703. Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and\n1193 should be forwarded to National Headquarters or to the proper Branch Office.\n0\n(OVER)\n&"
}