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Wep. cant badge senjin oar Nwos 6.S herman.
FORM NO. 1
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
1. Name of applicant Maryant Ll. In
Badge number
2. Address in full 849 Hope St. Island
39
3. Date of birth October 121-875
Place of birth Bristoe R.S.
4. Are you married, single or a widow? single
Are citizen of the United States?
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? No.
you a yes
6.
Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated Public school of Bustat R.I.
7. Occupation before entering training school home
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
R lude I land Hospital Providence R.4 6th 1901
July
9. Character of hospital: General yes
Special ? -
Private ?
10. Daily number of in training Length of course
average patients hospital during 24013 3 year
11. Name and address of superintendent of training school under whom you received training
Miss Lucy e. ayers Woonsocked Hospital
12. Of what nursing organizations are you a member ? R.I. Hospital Auses Club &
R.2. association of Performance
13. Give name and address of secretary of at least one of these organizations mis alida years
96 state St. Presidence Rx
14. a nurse
Are you registered ? yes In what state ? R.9. Date Lbs.2033-1912
of registration
15. State how, where and for what period of time, in each instance, you have been employed since graduation,
including present employment Subditute district nume Providence A.I four months,
substitute district Murse Peacedale R.F. one month
I'm change Woonsocket anti Tuberculosis Resociation work,
three years, duly nursing mine you
and
16. In the event of war are you willing to take the oath of allegiance
17. Name and permanent address of nearest relative Misa Olizabeth J/ langley
yes
849 Hope St. Bustoe R.H
Date april 27 - 1914
Signature Margard Le. I'll lungbay
This blank to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee
to be forwarded with "credentials" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. C.
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"ocrText": "Wep. cant badge senjin oar Nwos 6.S herman.\nFORM NO. 1\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\n1. Name of applicant Maryant Ll. In\nBadge number\n2. Address in full 849 Hope St. Island\n39\n3. Date of birth October 121-875\nPlace of birth Bristoe R.S.\n4. Are you married, single or a widow? single\nAre citizen of the United States?\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? No.\nyou a yes\n6.\nName educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated Public school of Bustat R.I.\n7. Occupation before entering training school home\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\nR lude I land Hospital Providence R.4 6th 1901\nJuly\n9. Character of hospital: General yes\nSpecial ? -\nPrivate ?\n10. Daily number of in training Length of course\naverage patients hospital during 24013 3 year\n11. Name and address of superintendent of training school under whom you received training\nMiss Lucy e. ayers Woonsocked Hospital\n12. Of what nursing organizations are you a member ? R.I. Hospital Auses Club &\nR.2. association of Performance\n13. Give name and address of secretary of at least one of these organizations mis alida years\n96 state St. Presidence Rx\n14. a nurse\nAre you registered ? yes In what state ? R.9. Date Lbs.2033-1912\nof registration\n15. State how, where and for what period of time, in each instance, you have been employed since graduation,\nincluding present employment Subditute district nume Providence A.I four months,\nsubstitute district Murse Peacedale R.F. one month\nI'm change Woonsocket anti Tuberculosis Resociation work,\nthree years, duly nursing mine you\nand\n16. In the event of war are you willing to take the oath of allegiance\n17. Name and permanent address of nearest relative Misa Olizabeth J/ langley\nyes\n849 Hope St. Bustoe R.H\nDate april 27 - 1914\nSignature Margard Le. I'll lungbay\nThis blank to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee\nto be forwarded with \"credentials\" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. C."
}