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1
S
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-4-33
3
Application for Enrollment
a
(To be filled out entirely in applicant's handwriting and each question answered fully.)
2. 1. Permanent Name of applicant address in in full full mary 1400 luest alice main Harrie It Wathan, Alabama
3. Date Probable of birth address Sept. for one 28 year 1400 1910 west Race main white st Walhane Place of birth mobile Ald alar
D
2
4. Are you single, married, a widow, or divorced? singled
Birthplace Are citizen of the United States? you (ister)
of (Month) father lead (Day) 7/5 (Year) Mother
Citizenship of father U.S.
-
-
you a
c
e
5. How many years have you attended Grammar school? 6 High school? 6 Normal school?
Private school? Partly College?
If tutored privately, name subjects covered and length
of time
6. What languages other than English do you speak? none
7. Occupation before entering school of nursing school. girl
(Underline those which you speak fluently)
8.
From what school of nursing did you receive your diploma? moody Hospital
City and State Walkan, ala
Date of graduation march 22, 1931
9. Character of Hospital: General? benual Special?
Private? you
10. Did your training include medical and surgical care of men? yes Of women yes
11. Daily average number of patients in hospital during training 50 Length of course 3 years
Pediatrics? yrs Obstetrics? yes Communicable diseases? yes
12, Name and address of superintendent of nurses under whom yougreceived training
mrs Lda Luscar - Woodland hune Wathen, ala
13. If your education as a nurse was received in more than one hospital, give name, location and time
spent in each no
you a member of your Alumnae Association? yes
Date of state registration July 10, 1931
ion through membership in District and
Signature of Nurse mary alice Harrie
in the District and Graduate Nurses' Associations of
state registration no. 3390
ite Association of which you are a member
n dt Wathan ala
Date of registration
Number 3390
18. Type of work and length of service, since graduation:
3 years duty
6
months nursing
" private of County nursing Health
6
camphell Business Calleg
19. Are you willing to accept service if the United States becomes involved in war? yes
20.
Or, service with the American Red Cross in time of disaster or great emergency? yes
Are you willing to take the oath of allegiance? yes
21.
Are you a qualified public health nurse, or teacher?
6
If so, please answer the questions on the reverse side of this blank.
22. Give name and permanent address of nearest relative or fréend, residing in the United States
2
(state relationship)
mrs g E Harrie mother (saster)
Date march 13-1935 Signature of Nurse mary Alice Harree
2
To the Local Committee:
J
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.
(OVER)
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Document data
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"ocrText": "I\nat\na\n1\nS\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-4-33\n3\nApplication for Enrollment\na\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n2. 1. Permanent Name of applicant address in in full full mary 1400 luest alice main Harrie It Wathan, Alabama\n3. Date Probable of birth address Sept. for one 28 year 1400 1910 west Race main white st Walhane Place of birth mobile Ald alar\nD\n2\n4. Are you single, married, a widow, or divorced? singled\nBirthplace Are citizen of the United States? you (ister)\nof (Month) father lead (Day) 7/5 (Year) Mother\nCitizenship of father U.S.\n-\n-\nyou a\nc\ne\n5. How many years have you attended Grammar school? 6 High school? 6 Normal school?\nPrivate school? Partly College?\nIf tutored privately, name subjects covered and length\nof time\n6. What languages other than English do you speak? none\n7. Occupation before entering school of nursing school. girl\n(Underline those which you speak fluently)\n8.\nFrom what school of nursing did you receive your diploma? moody Hospital\nCity and State Walkan, ala\nDate of graduation march 22, 1931\n9. Character of Hospital: General? benual Special?\nPrivate? you\n10. Did your training include medical and surgical care of men? yes Of women yes\n11. Daily average number of patients in hospital during training 50 Length of course 3 years\nPediatrics? yrs Obstetrics? yes Communicable diseases? yes\n12, Name and address of superintendent of nurses under whom yougreceived training\nmrs Lda Luscar - Woodland hune Wathen, ala\n13. If your education as a nurse was received in more than one hospital, give name, location and time\nspent in each no\nyou a member of your Alumnae Association? yes\nDate of state registration July 10, 1931\nion through membership in District and\nSignature of Nurse mary alice Harrie\nin the District and Graduate Nurses' Associations of\nstate registration no. 3390\nite Association of which you are a member\nn dt Wathan ala\nDate of registration\nNumber 3390\n18. Type of work and length of service, since graduation:\n3 years duty\n6\nmonths nursing\n\" private of County nursing Health\n6\ncamphell Business Calleg\n19. Are you willing to accept service if the United States becomes involved in war? yes\n20.\nOr, service with the American Red Cross in time of disaster or great emergency? yes\nAre you willing to take the oath of allegiance? yes\n21.\nAre you a qualified public health nurse, or teacher?\n6\nIf so, please answer the questions on the reverse side of this blank.\n22. Give name and permanent address of nearest relative or fréend, residing in the United States\n2\n(state relationship)\nmrs g E Harrie mother (saster)\nDate march 13-1935 Signature of Nurse mary Alice Harree\n2\nTo the Local Committee:\nJ\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C. 703.\nApplication forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193 should be\nforwarded to National Headquarters.\n(OVER)"
}