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N
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
16105
NURSING SERVICES
MILITARY SERIAL NUMBER
y
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
Kohler Ruby Esther
2651 St Joseph
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
+
Delphin William Kohler, M.D.
PERMANENT ADDRESS (street, sone, county, state)
PRESENT ADDRESS (Street, city, zone, county, state) St Joseph, Stearns, County, Minn.
11
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Delphin William Kohler, M.D.
Husband
S
DATE OF BIRTH (Month, day, year)
Single
Married
Separated
Widowed
Divorced
+
April 22, 1895
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
e
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
of Massachusetts
NURSES' ASSOCIATION?
x
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
Godd
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 sonths.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
Stearns County chapt x Hdgte 23 -5th Ave So. St Cloud Minn.
1. Teach home
YES
NO Ättend 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
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of disaster
In other communities
offered, in preparation for service
X
x
3. Teach nurse's
YES
NO
4. Accept membership on chapter com-
YES
NO
5. Assist with other chapter
YES
NO
aide classes
mittee should services be needed
programs, as needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
x
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS.
DATE
IGNATURE
Aug. 18. 1945
YOUR VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND PAITHPOLNESS IW
Ruly E. Kohler YOUR
KEEPING US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND REfURN If PROMPTLY TO THE
of
COMMITTES NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
HENNEPIN COUNTY NURSE RECRUITMENT COMMITTEE
NURSE RECRUITMENT
325 Groveland Avenue, Minneapolis 4, Minnesota
COMMITTEE
78504M
FORM 1045 Rev. July 1945
Page data
- Page
- 36
- Source index
- 0
- Type
- photo
- Media ID
- 1925ce347755396c
- Size
- unknown
Document data
- ID
- 2661774
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "N\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n16105\nNURSING SERVICES\nMILITARY SERIAL NUMBER\ny\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nKohler Ruby Esther\n2651 St Joseph\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\n+\nDelphin William Kohler, M.D.\nPERMANENT ADDRESS (street, sone, county, state)\nPRESENT ADDRESS (Street, city, zone, county, state) St Joseph, Stearns, County, Minn.\n11\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nDelphin William Kohler, M.D.\nHusband\nS\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nWidowed\nDivorced\n+\nApril 22, 1895\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\ne\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nof Massachusetts\nNURSES' ASSOCIATION?\nx\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nGodd\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 to\nserve if called on within the next 12 sonths.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nStearns County chapt x Hdgte 23 -5th Ave So. St Cloud Minn.\n1. Teach home\nYES\nNO Ättend 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\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\nX\nx\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nx\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nDATE\nIGNATURE\nAug. 18. 1945\nYOUR VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND PAITHPOLNESS IW\nRuly E. Kohler YOUR\nKEEPING US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND REfURN If PROMPTLY TO THE\nof\nCOMMITTES NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nHENNEPIN COUNTY NURSE RECRUITMENT COMMITTEE\nNURSE RECRUITMENT\n325 Groveland Avenue, Minneapolis 4, Minnesota\nCOMMITTEE\n78504M\nFORM 1045 Rev. July 1945"
}