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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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Document data
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- Core
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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"
}