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Peterson, Olivia I., Badge #10,895
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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
NURSING SERVICES
ANNUAL QUESTIONNAIRE - 1945
Q
MILITARY SERIAL NUMBER
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
Peterson Ohioia T.
TELEPHONE NO.
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
PERMANENT ADDRESS (Street, city, zone, county, state)
Starbuck
min
PRESENT ADDRESS (Street, city, zone, county, state)
NAME 4923 AND ADDRESS Brendywins OF RELATIVE OR FRIEND St h.W. Washington DC
NEAREST IN THE UNITED STATES
RELATIONSHIP
Haruld R. Peterson Prinction minn
DATE OF BIRTH (Month, day, year)
BroTher
mch.19-18go
Single
Married
+
Separated
Widowed
Divorced
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
horwegian
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
University of minn mp/s.minn 1919
for
DIPLOMA
MAJOR
AUG 18 1945 3
HURSING
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THESAMERICAN
YES
NO
REGISTERED?
V
minni
NURSES' ASSOCIATION?
J
PRESENT EMPLOYMENT If not employed, sheck TIF
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
NAME OF
HOSPITAL asst. OR ORGANIZATION Pir aRe BY WHOM nursing EMPLOYED service
washi AC
CITY
am-RC.
STATE
HEALTH
good
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upor to respond to a
call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are wi ling and able
to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1. Teach home
YES
NO Attend an instructors' training program, if offered. (Fundsare availableOfor
many
YES NO
nursing classes
training home nursing instructors. See local chapter.)
GVST
2. Serve in case
agino
YES
NO
only in home community
Attend disaster institutesNYY
YES NO
of disaster
In other communities
offered, in preparation for service
8
3. Teach nurse's
YES
NO
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chanter YES
NO
aide classes
mittee should services be needed
9
programs, as-needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS.
D'ATE
YOUR
VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS
Aug 15 - 1945
SIGNATURE Plina I Peterson
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO
TKE IN
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
NATIONAL HEADQUARTERS
COMMITTEE
78504M
FORM 1045 Rev. July 1945
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"ocrText": "e\nPeterson, Olivia I., Badge #10,895\nek\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\nNURSING SERVICES\nANNUAL QUESTIONNAIRE - 1945\nQ\nMILITARY SERIAL NUMBER\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nPeterson Ohioia T.\nTELEPHONE NO.\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\nStarbuck\nmin\nPRESENT ADDRESS (Street, city, zone, county, state)\nNAME 4923 AND ADDRESS Brendywins OF RELATIVE OR FRIEND St h.W. Washington DC\nNEAREST IN THE UNITED STATES\nRELATIONSHIP\nHaruld R. Peterson Prinction minn\nDATE OF BIRTH (Month, day, year)\nBroTher\nmch.19-18go\nSingle\nMarried\n+\nSeparated\nWidowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nhorwegian\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nUniversity of minn mp/s.minn 1919\nfor\nDIPLOMA\nMAJOR\nAUG 18 1945 3\nHURSING\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THESAMERICAN\nYES\nNO\nREGISTERED?\nV\nminni\nNURSES' ASSOCIATION?\nJ\nPRESENT EMPLOYMENT If not employed, sheck TIF\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF\nHOSPITAL asst. OR ORGANIZATION Pir aRe BY WHOM nursing EMPLOYED service\nwashi AC\nCITY\nam-RC.\nSTATE\nHEALTH\ngood\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upor to respond to a\ncall\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are wi ling and able\nto\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nYES\nNO Attend an instructors' training program, if offered. (Fundsare availableOfor\nmany\nYES NO\nnursing classes\ntraining home nursing instructors. See local chapter.)\nGVST\n2. Serve in case\nagino\nYES\nNO\nonly in home community\nAttend disaster institutesNYY\nYES NO\nof disaster\nIn other communities\noffered, in preparation for service\n8\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chanter YES\nNO\naide classes\nmittee should services be needed\n9\nprograms, as-needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nD'ATE\nYOUR\nVALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS\nAug 15 - 1945\nSIGNATURE Plina I Peterson\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO\nTKE IN\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nNATIONAL HEADQUARTERS\nCOMMITTEE\n78504M\nFORM 1045 Rev. July 1945"
}