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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON. D. c.
16
QUESTIONNAIRES DESTROYED
Dear Red Cross Nurse:
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
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.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Miss Mary C. Walker
Chairman or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
Secretary, State and Local Committees
which they are enrolled. Do not forget
Red Cross Nursing Service Local Committee.
the address of the Secretary.
Denver General Hospital
Name in full AlieF EVANGELINE LAKEVER
Colorado
If married, give husband's name
Permanent address 2307 w.41 st Ave Denver Denver Colo.
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year 2307 West 41st Ave,
(STREET. ETC.)
Telephone No. gal.1548J
Denver
Colo
(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)
C.W.bAKE father
Underline the type of work you are now doing:
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 Would you like to teach Red Cross classes? no.
Indicate present physical condition fair
(too lo)
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? no.
Badge No. 884
Current date Feb. 20-1939
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.

Page data

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ID: 2661787
Core: doc
Type: document

DTO data

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Context sent to Scholar

Document identity

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Document source extras

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Page context

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    "mediaId": "fd4ff43f199d1924",
    "ocrText": "+\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON. D. c.\n16\nQUESTIONNAIRES DESTROYED\nDear Red Cross Nurse:\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\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.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nMiss Mary C. Walker\nChairman or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nSecretary, State and Local Committees\nwhich they are enrolled. Do not forget\nRed Cross Nursing Service Local Committee.\nthe address of the Secretary.\nDenver General Hospital\nName in full AlieF EVANGELINE LAKEVER\nColorado\nIf married, give husband's name\nPermanent address 2307 w.41 st Ave Denver Denver Colo.\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year 2307 West 41st Ave,\n(STREET. ETC.)\nTelephone No. gal.1548J\nDenver\nColo\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)\nC.W.bAKE father\nUnderline the type of work you are now doing:\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 Would you like to teach Red Cross classes? no.\nIndicate present physical condition fair\n(too lo)\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? no.\nBadge No. 884\nCurrent date Feb. 20-1939\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."
}

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