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M
FORM 1037
REV. JULY 1941
AMERICAN RED CROSS
NURSING SERVICE
school
APPLICATION FOR ENROLLMENT
disluit
(To be filled out in applicant's handwriting and each question answered fully)
1. Name of applicant in full
mac Donald Ida mildred
If married, give maiden name
2. Permanent
address 815 Essex S.E munncapolic Hennefin mean
(Street)
(City)
(County)
(State)
3. Probable address for one year
same
a
(Street)
(City)
(County)
(State)
4. Name and permanent address of nearest relative or friend residing in the United States:
Edith mac Donald
(Name)
(Address) #3 Rozale mussaula (Relationshîp) montana Sister
5. Race
6. Present Marital Status
7. Citizenship
8. What languages other than English do you
speak?
Mi
2 White
X Single
Native born
None
German
-
Negro
Married
Naturalized
Spanish
Scandinavian
Other
Widowed
Non citizen
French
Polish
a
Divorced
Nationality
Italian
Other
Scatch
Catholic Sister
e
9. Date of birth nov 13,1899 Place of birth W instructives moutor Is Father a citizen
Yes
but
Birthplace of Father nova sentia Mother Nova Seation
of the United States?
No
deceased
10. General education (prior to entering nursing) :
Did you graduate from high school
X1
Yes If no, how many years of high school do you lack?
No
What college or university education did you have prior to entering nursing?
o
None or less
1 1 year;
2 years;
3 3 years;
X. Bachelor's
5 Master's
Ph.D.
than 1 year;
Degree;
Degree;
11. Nursing Education:
a. School of nursing from which
graduated Preobyterian Hospital (Name) Chicago (City) Illinois
(State)
Date of graduation
Agro
1
19 31
Length of course:
5 years;
3 years;
(Specify other)
b. Undergraduate affiliations:
Clinical
Hospital or Organization
City and State
specialty
No. months
(1) Wurand contagroins Hospital cheeage Ill
Contagrom
3
(2)
(3)
c. Postgraduate clinical courses (Do not include academic work or employment)
Clinical
Inclusive
Hospital or Organization
City and State
specialty
dates
(1)
(2)
(3)
I
d. Academic study since graduation from School of Nursing:
Number of full time
Number of
13
College or University
City and State
academic years
points
is
(1) University minnesota minneapolis
24quarle credits
(2)
23 graduate walts
(3)
m Ed PRych
e. Check all degrees obtained
4 Bachelor's
5
Master's
Ph.D.
Certificate in Public Health
5
subsequent to entering training:
Degree;
Degree;
Nursing
f. In which major field was your academic study?
1 Institutional
Public Health
a
5 Non nursing (specify) Social Science
&
Other (specify)
W
13 6806E221OWVT VELITIVLION
Educational Psychology
(OVER)
Page data
- Page
- 48
- Source index
- 0
- Type
- photo
- Media ID
- 6658bb29611eb9dc
- Size
- unknown
Document data
- ID
- 2661860
- Core
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- document
DTO data
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"ocrText": "M\nFORM 1037\nREV. JULY 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nschool\nAPPLICATION FOR ENROLLMENT\ndisluit\n(To be filled out in applicant's handwriting and each question answered fully)\n1. Name of applicant in full\nmac Donald Ida mildred\nIf married, give maiden name\n2. Permanent\naddress 815 Essex S.E munncapolic Hennefin mean\n(Street)\n(City)\n(County)\n(State)\n3. Probable address for one year\nsame\na\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nEdith mac Donald\n(Name)\n(Address) #3 Rozale mussaula (Relationshîp) montana Sister\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nspeak?\nMi\n2 White\nX Single\nNative born\nNone\nGerman\n-\nNegro\nMarried\nNaturalized\nSpanish\nScandinavian\nOther\nWidowed\nNon citizen\nFrench\nPolish\na\nDivorced\nNationality\nItalian\nOther\nScatch\nCatholic Sister\ne\n9. Date of birth nov 13,1899 Place of birth W instructives moutor Is Father a citizen\nYes\nbut\nBirthplace of Father nova sentia Mother Nova Seation\nof the United States?\nNo\ndeceased\n10. General education (prior to entering nursing) :\nDid you graduate from high school\nX1\nYes If no, how many years of high school do you lack?\nNo\nWhat college or university education did you have prior to entering nursing?\no\nNone or less\n1 1 year;\n2 years;\n3 3 years;\nX. Bachelor's\n5 Master's\nPh.D.\nthan 1 year;\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\ngraduated Preobyterian Hospital (Name) Chicago (City) Illinois\n(State)\nDate of graduation\nAgro\n1\n19 31\nLength of course:\n5 years;\n3 years;\n(Specify other)\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1) Wurand contagroins Hospital cheeage Ill\nContagrom\n3\n(2)\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nInclusive\nHospital or Organization\nCity and State\nspecialty\ndates\n(1)\n(2)\n(3)\nI\nd. Academic study since graduation from School of Nursing:\nNumber of full time\nNumber of\n13\nCollege or University\nCity and State\nacademic years\npoints\nis\n(1) University minnesota minneapolis\n24quarle credits\n(2)\n23 graduate walts\n(3)\nm Ed PRych\ne. Check all degrees obtained\n4 Bachelor's\n5\nMaster's\nPh.D.\nCertificate in Public Health\n5\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\n1 Institutional\nPublic Health\na\n5 Non nursing (specify) Social Science\n&\nOther (specify)\nW\n13 6806E221OWVT VELITIVLION\nEducational Psychology\n(OVER)"
}