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FORM NO. 1
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
1. Name of applicant Alyce nella Homewood Badge number
2. Address in full 141 Fayerweather 30- Street Cambredge mass
29
3. Date of birth Sept. 2, 1887
Place of birth Biddiford maine
4. Are you married, single defects or a widow? or tendency single to constitutional Are or pulmonary you a citizen trouble? of the United no States? Yes
5.
Have
you
any
physical
e
6. Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated Graduate Public Grammar Schure
Haverhell mass
Haverhill mass - - Three years of Haverhell High Fehre
7. Occupation before entering training school Clerical (affee unk)
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
new England pleasoness Haspital Road Biston mass
9. Character of hospital: General
Special ?
Private ? yes
10. Daily average number of patients in hospital during training
70
Length of course 3 years
11. Name and address of superintendent of training school under whom you received training
Adeliza a Betts 175Pilgrem Rd. Boston mass
12.
Of what nursing organizations are you a member ? Deaconess Hospital Alummi
T mass State nurses asen
13. Give name and address of secretary of at least one of these organizations
Charlotte Dana R.N. 24 me Lean Sr. Boston mass
14. Are you a registered nurse ? Yes
In what state ? mass Date of registration april 12, 1916
15. State how, where and for what period of time, in each instance, you have been employed since graduation,
including present employment How done private murcui swice
graduation
16. In the event of war are you willing to take the oath of allegiance ? you
17. Name and permanent address of nearest relative Mrs Arthur It Incholo (sister)
129 main Street Southbridge mass
Date april 9, 19.7
Signature Alyan n
sent to applicant with circular letter and rules governing enrollment. After approval and endorsement Service, by Washington, local Committee D. c.
to
be
This forwarded blank with is to be " credentials" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing
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Document data
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- 2661835
- Core
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- Type
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DTO data
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Context sent to Scholar
Document identity
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Document source extras
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"ocrText": "FORM NO. 1\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\n1. Name of applicant Alyce nella Homewood Badge number\n2. Address in full 141 Fayerweather 30- Street Cambredge mass\n29\n3. Date of birth Sept. 2, 1887\nPlace of birth Biddiford maine\n4. Are you married, single defects or a widow? or tendency single to constitutional Are or pulmonary you a citizen trouble? of the United no States? Yes\n5.\nHave\nyou\nany\nphysical\ne\n6. Name educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated Graduate Public Grammar Schure\nHaverhell mass\nHaverhill mass - - Three years of Haverhell High Fehre\n7. Occupation before entering training school Clerical (affee unk)\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\nnew England pleasoness Haspital Road Biston mass\n9. Character of hospital: General\nSpecial ?\nPrivate ? yes\n10. Daily average number of patients in hospital during training\n70\nLength of course 3 years\n11. Name and address of superintendent of training school under whom you received training\nAdeliza a Betts 175Pilgrem Rd. Boston mass\n12.\nOf what nursing organizations are you a member ? Deaconess Hospital Alummi\nT mass State nurses asen\n13. Give name and address of secretary of at least one of these organizations\nCharlotte Dana R.N. 24 me Lean Sr. Boston mass\n14. Are you a registered nurse ? Yes\nIn what state ? mass Date of registration april 12, 1916\n15. State how, where and for what period of time, in each instance, you have been employed since graduation,\nincluding present employment How done private murcui swice\ngraduation\n16. In the event of war are you willing to take the oath of allegiance ? you\n17. Name and permanent address of nearest relative Mrs Arthur It Incholo (sister)\n129 main Street Southbridge mass\nDate april 9, 19.7\nSignature Alyan n\nsent to applicant with circular letter and rules governing enrollment. After approval and endorsement Service, by Washington, local Committee D. c.\nto\nbe\nThis forwarded blank with is to be \" credentials\" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing"
}