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DMM1
N
THE AMERICAN RED CROSS
NURSING SERVICE
e
a
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
5
I.
2. Address in full, Wallent Sti City feul intomers State Pennan
Name of applicant in full it athryn magdeleus human R.U.
n
3. Date of birth march 24. 1893 Place of birth aruprior Out. Canada
4. Are you married, single or a widow? single
Are you a citizen of the United States? no
Have you any physical defects or tendency to constitutional or pulmonary trouble?
noue
a
5.
I
Are you physically strong and healthy?
yes
n
6. Name educational institutions attended before entering training school, stating number of years at each and from which you
were graduated
graduate of Public school of
T
arepair Onlario Cauadan
+
7. What languages other than English do you speak?
wou'd
5
8.
Occupation before entering training school
9.
hospital training school did you receive your diploma? abington memorial Hospital
not any
From
what
City and state
Purian abrugton Date of graduation april 26.1917
M
IO. Character of hospital: General?
yes
Special?
-
Private?
II. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? no.
12.
13. Name and address of superintendent of training school under whom you received training miss olm Funct
Daily average number of patients in hospital during training 40-45 Length of course 2 years.
abrungtin memorial Hospital atrugton! Pan
14.
If your training as a nurse was received in more than one hospital, give name, location and time spent in each
15. Of what nursing organizations are you a member?
not any
16. Which, if any, is affiliated with the American Nurses Association?
17. Give name and address of sécretary of at least one of these organizations
1917.
18. Are you a registered nurse? yes In what state? Pa. Date of registration func22ta Number: 10312
19. How and where employed since graduation:
Give dates with months.
Name and address of employers:
Si isstituting for 1mouth
may, stronue
miss Fruct
is abuggion Hospital
1st
abugin mem Hospital
Private nursay
June 1st till
Dr. Crss Pa jeukiutrum
abugin Pa
present time
Dr.M.K. heiffer
Pa
(Specify for which of the following services you wish to be considered.)
20.
War service, wherever needed. Foreign service perfermed available
Are you willing to take the oath of allegiance?
yest
any thus
21. Instructor, Elementary Hygiene
22. Public Health Nursing -
In Town and Country Nursing Service
-
or for War Service yes
23. Name and permanent nearest
address of relative ur Robt.7 neurance
imprior Rutance Canada
Date april 8-1918
Signature of Nurse Kathryn m
To the Committee:
This blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, and A. R. C. I50.
Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorse-
ment by Local Committee, with credentials (Forms 3 and 4), together with Forms IO and II, should be forwarded to the Chair-
man, National Committee on Nursing Service, American Red Cross, Washington, D. C.
In case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local
Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-
mittee, from whence credentials will be procured.
REQ.-17-2125B-20M-Nov
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"ocrText": "DMM1\nN\nTHE AMERICAN RED CROSS\nNURSING SERVICE\ne\na\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n5\nI.\n2. Address in full, Wallent Sti City feul intomers State Pennan\nName of applicant in full it athryn magdeleus human R.U.\nn\n3. Date of birth march 24. 1893 Place of birth aruprior Out. Canada\n4. Are you married, single or a widow? single\nAre you a citizen of the United States? no\nHave you any physical defects or tendency to constitutional or pulmonary trouble?\nnoue\na\n5.\nI\nAre you physically strong and healthy?\nyes\nn\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nwere graduated\ngraduate of Public school of\nT\narepair Onlario Cauadan\n+\n7. What languages other than English do you speak?\nwou'd\n5\n8.\nOccupation before entering training school\n9.\nhospital training school did you receive your diploma? abington memorial Hospital\nnot any\nFrom\nwhat\nCity and state\nPurian abrugton Date of graduation april 26.1917\nM\nIO. Character of hospital: General?\nyes\nSpecial?\n-\nPrivate?\nII. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? no.\n12.\n13. Name and address of superintendent of training school under whom you received training miss olm Funct\nDaily average number of patients in hospital during training 40-45 Length of course 2 years.\nabrungtin memorial Hospital atrugton! Pan\n14.\nIf your training as a nurse was received in more than one hospital, give name, location and time spent in each\n15. Of what nursing organizations are you a member?\nnot any\n16. Which, if any, is affiliated with the American Nurses Association?\n17. Give name and address of sécretary of at least one of these organizations\n1917.\n18. Are you a registered nurse? yes In what state? Pa. Date of registration func22ta Number: 10312\n19. How and where employed since graduation:\nGive dates with months.\nName and address of employers:\nSi isstituting for 1mouth\nmay, stronue\nmiss Fruct\nis abuggion Hospital\n1st\nabugin mem Hospital\nPrivate nursay\nJune 1st till\nDr. Crss Pa jeukiutrum\nabugin Pa\npresent time\nDr.M.K. heiffer\nPa\n(Specify for which of the following services you wish to be considered.)\n20.\nWar service, wherever needed. Foreign service perfermed available\nAre you willing to take the oath of allegiance?\nyest\nany thus\n21. Instructor, Elementary Hygiene\n22. Public Health Nursing -\nIn Town and Country Nursing Service\n-\nor for War Service yes\n23. Name and permanent nearest\naddress of relative ur Robt.7 neurance\nimprior Rutance Canada\nDate april 8-1918\nSignature of Nurse Kathryn m\nTo the Committee:\nThis blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, and A. R. C. I50.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorse-\nment by Local Committee, with credentials (Forms 3 and 4), together with Forms IO and II, should be forwarded to the Chair-\nman, National Committee on Nursing Service, American Red Cross, Washington, D. C.\nIn case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local\nCommittee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-\nmittee, from whence credentials will be procured.\nREQ.-17-2125B-20M-Nov"
}