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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
11th
M
WASHINGTON, D.C.
1
S
D
III
7
a
le
-
Dear Red Cross Nurse:
+
5
+1
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
A
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
C
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
F. ELNA SMITTEN,
Chairman or
Nurses should report at once to the
Secrotary Local. Committee
Secretary.
Secretary of the Local Committee under
RED CROSS NURSING SERVICE
which they are enrolled. Do not forget
519 Smithfield St.
Local Committee.
the address of the Secretary.
PITTSBURGH, PA.
Name in full Edith Pattern Hooly
Probable address for the next year 4060 Vinceton St. Pah. Pa
Permanent address 4060 Vinceton (STREET. STC.) St. (14) (CITY) Pittshergh ACOUNTY) Allegang (SFATE)
If married, give husband's name gah P. Higalay
(STREET, ETC.)
Telephone No Wellington 2435
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
mr. Underline Jedness the type Q of work Hirley you are/now doing: Hesband
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
Have you ever been? yes-once Would you like to teach Red Cross classes? yes
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No. 45438
Current date Fiturey 6, 1940
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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"ocrText": "I\nI\n0\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\n11th\nM\nWASHINGTON, D.C.\n1\nS\nD\nIII\n7\na\nle\n-\nDear Red Cross Nurse:\n+\n5\n+1\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nA\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nC\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nF. ELNA SMITTEN,\nChairman or\nNurses should report at once to the\nSecrotary Local. Committee\nSecretary.\nSecretary of the Local Committee under\nRED CROSS NURSING SERVICE\nwhich they are enrolled. Do not forget\n519 Smithfield St.\nLocal Committee.\nthe address of the Secretary.\nPITTSBURGH, PA.\nName in full Edith Pattern Hooly\nProbable address for the next year 4060 Vinceton St. Pah. Pa\nPermanent address 4060 Vinceton (STREET. STC.) St. (14) (CITY) Pittshergh ACOUNTY) Allegang (SFATE)\nIf married, give husband's name gah P. Higalay\n(STREET, ETC.)\nTelephone No Wellington 2435\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nmr. Underline Jedness the type Q of work Hirley you are/now doing: Hesband\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you ever been? yes-once Would you like to teach Red Cross classes? yes\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No. 45438\nCurrent date Fiturey 6, 1940\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}