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For Office Use Only
.IIE
FORM 1219
REV. AUG. 1941
Date Auth
AMERICAN RED CROSS
Type of Auth
Chapter
APPLICATION FORM
State
0110
PUBLIC HEALTH NURSE
Confidential
and
RED CROSS HOME NURSING INSTRUCTOR
Please return
Date Dec. 11 th 1941
I. PERSONAL
C
Name in full Miss Dorothy
Ledyard
Badge (No 17925
(H.D.
(MISS OR MRS)
(IF MARRIED. GITE MAIDEN NAME)
Not enrolled
Present address 1345-Taylor (STREET) Str. (CITY) San Francisco (STATE) Tel. No Ordway 3322
Permanent address Carmel, Calif
Tel. No
(STREET)
(CITY)
(STATE)
Date of birth nou. ST 1886
Marital status Single
bell
(SINGLE, MARRIED, WIDOWED, DIVORCED)
Race Causasian
Citizenship American
II. EDUCATION
1. Prior to entering school of nursing
Diploma
of
Name
City and State
Dates
or Degree
Major
of
High School
San Jose High School
Normal School
or University
mills College graduate
Other
2. School of nursing from which you graduated
Name Childrens Hospital francisco
Location California Date of graduation 1917 Length of course 3 years
(CITY PSTATE)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
4. Academic study since graduation from school of nursing
College or University or
Diploma
postgraduate course
City and State No Months
or Degree
Major
Western Reserve Univ. Cleveland
6
Public
Kings College for Women London Ehjo 8 diploma
Health
What courses in principles of teaching have you
Ens. had? Included To some extent
in public health courses
Have you had a course in practice teaching? no
Do you hold a state teacher's certificate? no
Where
Do you speak a foreign language? Some French German
(Over)
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"ocrText": "3\nFor Office Use Only\n.IIE\nFORM 1219\nREV. AUG. 1941\nDate Auth\nAMERICAN RED CROSS\nType of Auth\nChapter\nAPPLICATION FORM\nState\n0110\nPUBLIC HEALTH NURSE\nConfidential\nand\nRED CROSS HOME NURSING INSTRUCTOR\nPlease return\nDate Dec. 11 th 1941\nI. PERSONAL\nC\nName in full Miss Dorothy\nLedyard\nBadge (No 17925\n(H.D.\n(MISS OR MRS)\n(IF MARRIED. GITE MAIDEN NAME)\nNot enrolled\nPresent address 1345-Taylor (STREET) Str. (CITY) San Francisco (STATE) Tel. No Ordway 3322\nPermanent address Carmel, Calif\nTel. No\n(STREET)\n(CITY)\n(STATE)\nDate of birth nou. ST 1886\nMarital status Single\nbell\n(SINGLE, MARRIED, WIDOWED, DIVORCED)\nRace Causasian\nCitizenship American\nII. EDUCATION\n1. Prior to entering school of nursing\nDiploma\nof\nName\nCity and State\nDates\nor Degree\nMajor\nof\nHigh School\nSan Jose High School\nNormal School\nor University\nmills College graduate\nOther\n2. School of nursing from which you graduated\nName Childrens Hospital francisco\nLocation California Date of graduation 1917 Length of course 3 years\n(CITY PSTATE)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\npostgraduate course\nCity and State No Months\nor Degree\nMajor\nWestern Reserve Univ. Cleveland\n6\nPublic\nKings College for Women London Ehjo 8 diploma\nHealth\nWhat courses in principles of teaching have you\nEns. had? Included To some extent\nin public health courses\nHave you had a course in practice teaching? no\nDo you hold a state teacher's certificate? no\nWhere\nDo you speak a foreign language? Some French German\n(Over)"
}