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FORM NO. 1 EFICAN RED UNIVERSITY OF VIRGIN COOSE BASE HOSPITAL UNIE UNIVERSITY, WASHINGTON OF VIRGINIA NURSING SERVICE APPLICATION FOR ENROLLMENT (To be filled out entirely in applicant's handwriting) Name of applicant in full Fracises Bishop Credier I. 2. Address in full aw 91 et st how york City n-y. 3. Date of birth Sept 15th 1893 Place of birth Bristol R.J. 4. Are you married, single or a widow? single Are you a citizen of the United States? yes 5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no. 6. Name educational institutions attended before entering training school, stating number of years at each and from which you were graduated Bristol School 8 yrs Bristol High school Bristal Pil 2 yrs 7. Occupation before entering training school at home 8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation th St many free Ampleat for Childreas April 30th 1915 405 3 34th St. new yurb City If your training as a nurse was received in more than one hospital, give name, location and time spent in each Syring 9. In. 21 Out 17th St. Feb 1 - may 51914 Ronevett Hap 5 9th SJ children augi-havi IO. Character of hospital: General? Special? Private? 1 II. Did your training include the care of men? yes Contagious diseases? Greasimobstetrics? case yes 12. Daily average number of patients in hospital during training 90 Length of course. 21 yrs 13. Name and address of superintendent of training school under whom you received training Sister Eather elements. 405 w 34th St. how york City my 14. Of what nursing organizations are you a member? Sa mary Alumos an Public Health hursing Cess. 15. Which, if any, is affiliated with the American Nurses Association? Public Health huseur Cess 16. Give name and address of secretary of at least one of these organizations. his marion Seriette 224 musod love lepper monthlain ng 17. Are you a registered nurse? In what yes state? hys Date of registration 1911 18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present employment Substitutes @ wills D shemany St manys Hooks. milet months. Supervisor St. Settlement many trans for protrict 3 1> nursing since bet 1st 1916 up to present mo 19. Should our country be involved in war, would you be available for active service? yes 20. Would you be willing to take the oath of allegiance? yes 21. What languages other than English do you speak? were 22. Name and permanent address of nearest relative mrs a.w Ancher 9w 91 at ST. h.y. City hh Date June 1917 Signature Frances B. ander This blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. After approval and endorsement by local Committee to be forwarded with "credentials" (Forms Nos. 3 and 4) together with Forms 10-11 to the Chairman, National Committee on Red Cross Nursing Service, Washington, D.C. REQ. 16-511-JUNE-5000

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31ce39942c4dea54
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2661919
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Type
document
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    "ocrText": "FORM NO. 1\nEFICAN\nRED\nUNIVERSITY OF VIRGIN\nCOOSE\nBASE HOSPITAL UNIE\nUNIVERSITY,\nWASHINGTON OF\nVIRGINIA\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nName of applicant in full\nFracises Bishop Credier\nI.\n2. Address in full\naw 91 et st how york City n-y.\n3. Date of birth\nSept 15th 1893\nPlace of birth Bristol R.J.\n4. Are you married, single or a widow?\nsingle\nAre you a citizen of the United States?\nyes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno.\n6.\nName educational institutions attended before entering training school, stating number of years at each and from which you\nwere graduated\nBristol School 8 yrs\nBristol High school Bristal Pil 2 yrs\n7. Occupation before entering training school\nat home\n8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation\nth St many free Ampleat for Childreas\nApril 30th\n1915 405 3 34th St. new yurb City\nIf your training as a nurse was received in more than one hospital, give name, location and time spent in each\nSyring 9. In. 21 Out 17th St. Feb 1 - may 51914 Ronevett Hap 5 9th SJ\nchildren\naugi-havi\nIO. Character of hospital: General?\nSpecial?\nPrivate?\n1\nII. Did your training include the care of men? yes Contagious diseases? Greasimobstetrics? case\nyes\n12. Daily average number of patients in hospital during training 90\nLength of course.\n21 yrs\n13.\nName and address of superintendent of training school under whom you received training\nSister Eather elements. 405 w 34th St. how york City my\n14. Of what nursing organizations\nare you a member? Sa mary Alumos an\nPublic Health hursing Cess.\n15.\nWhich,\nif\nany,\nis\naffiliated\nwith the American Nurses Association? Public Health huseur Cess\n16. Give name and address of secretary of at least one of these organizations.\nhis marion Seriette\n224 musod love lepper monthlain ng\n17. Are you a registered nurse?\nIn what\nyes\nstate? hys Date of registration 1911\n18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present\nemployment Substitutes @ wills D shemany St manys Hooks.\nmilet months. Supervisor St. Settlement many trans for\nprotrict 3 1> nursing since bet 1st 1916\nup to present mo\n19. Should our country be involved in war, would you be available for active service?\nyes\n20. Would you be willing to take the oath of allegiance?\nyes\n21. What languages other than English do you speak?\nwere\n22. Name and permanent address of nearest relative\nmrs a.w Ancher\n9w 91 at ST. h.y. City hh\nDate June\n1917\nSignature Frances B. ander\nThis blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. After\napproval and endorsement by local Committee to be forwarded with \"credentials\" (Forms Nos. 3 and 4) together with Forms 10-11 to the\nChairman, National Committee on Red Cross Nursing Service, Washington, D.C.\nREQ. 16-511-JUNE-5000"
}