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DMR1 THE AMERICAN RED CROSS DEPARTMENT OF NURSING 24th Application for Enrollment (To be filled out entirely in applicant's handwriting and each question answered fully) 1. Name of 3. Date of birth may 1878 2. Address in full, Street 744 asklaud City Buffalo State ny applicant in full Julia Cafaria Smith Place 4. Are you married, single or a widow sungle of birth Cauandhique Are you a citizen of the United States? 5. Have you any physical defects or tendency to constitutional or pulmonary trouble? Sligth Are you physically strong and healthy? fairly strong 6. Name educational institutions attended before entering training school, stating number of years at each and from High School Induate n.4 which you were graduated Graumer school particilal 9 yrs good 7. What languages other than English do you speak? 8. Occupation before entering training school 9. From what hospital training school did you receive Rochester N. Y your diploma? Hospital City and state Date of graduation June 1908 10. Character of hospital General? 11. Did your training include obstetrics? uses yes Care of men? yes Children? you Contagious diseases Thony Special? Private? 12. Daily average number of patients in hospital during training 100 Length of course 3 13 Name and address of superintendent of training school under whom you received training yrs miss m. S. Keith Rochester n. g 14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each no 15. Of what nursing organizations are you a member Rochester Several- national Public Health and new york Stale Public Health 16. Which, if any, is affiliated with the American Nurses Association? all three 17. Give name and address of secretary of at least one of these organizations. Mis Heny Gibboas Dept of health Buffalo n.y 18. Are you a registered nurse? yes In what state? n. 4 Date of registration Je 1918 Number. Private nurse 19. How and where employed since graduation : Give dates with months Name and address of employers 9 yrs Dr E.n. mulligan Student al Teachers College 8 mom Public Health Course Miss Adeliede Multing Teacher's College newymberty Bublic Health Eric C 6 mo. Hugs a Bread Supervisiony nurseiu Tuberculosis 145 Derau Sh Buffalo (Specify for which of the following services you wish to be considered.) 20. War service, wherever needed When available 1mo notice ny yes Are you willing to take the oath of allegiance? 21. Instructor, Elementary Hygiene yes 22. Public Health Nursing yes In Town and Country Nursing, Service 23. Name and permanent address of nearest relative Mrs Er J. or for War Service 744 ask Caud are Buffalo Screency Date floo 27-1918 Signature of Nurse Julia Catherine L.Smith To the Committee: C. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval 703. This blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, 29 and A. R. and warded endorsement by Local Committee, with credentials (Form 3 and 4), together with Forms 10, 11 and 29, should be for- Washington, D. C. through the Director of the Bureau of Nursing in your Division to the Department of Nursing, American Red Cross, 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 Committee, from whence credentials will be procured. (SEE OTHER SIDE)

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54
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0
Type
photo
Media ID
9bc2011a108d5651
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unknown

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2662273
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Type
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        "logicalDate": "1942-12-21",
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Page context
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    "ocrText": "DMR1\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\n24th\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1.\nName\nof\n3. Date of birth may 1878\n2. Address in full, Street 744 asklaud City Buffalo State ny\napplicant in full Julia Cafaria Smith\nPlace\n4. Are you married, single or a widow\nsungle\nof birth Cauandhique\nAre\nyou\na\ncitizen\nof\nthe\nUnited\nStates?\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? Sligth\nAre\nyou physically strong and healthy? fairly strong\n6. Name educational institutions attended before entering training school, stating number of years at each and from\nHigh School Induate n.4\nwhich you were graduated Graumer school particilal 9 yrs good\n7. What languages other than English do you speak?\n8. Occupation before entering training school\n9. From what hospital training school did you receive\nRochester N. Y\nyour diploma? Hospital\nCity and state\nDate of graduation June 1908\n10. Character of hospital General?\n11. Did your training include obstetrics? uses yes Care of men? yes Children? you Contagious diseases Thony\nSpecial?\nPrivate?\n12. Daily average number of patients in hospital during training 100 Length of course 3\n13 Name and address of superintendent of training school under whom you received training\nyrs\nmiss m. S. Keith Rochester n. g\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each no\n15. Of what nursing organizations are you a member Rochester Several- national\nPublic Health and new york Stale Public Health\n16. Which, if any, is affiliated with the American Nurses Association?\nall three\n17. Give name and address of secretary of at least one of these organizations. Mis Heny Gibboas\nDept of health Buffalo n.y\n18. Are you a registered nurse? yes In what state? n. 4 Date of registration Je 1918 Number.\nPrivate nurse\n19. How and where employed since graduation :\nGive dates with months\nName and address of employers\n9 yrs\nDr E.n. mulligan\nStudent al Teachers College\n8 mom\nPublic Health Course\nMiss Adeliede Multing\nTeacher's College newymberty\nBublic Health Eric C\n6 mo.\nHugs a Bread\nSupervisiony nurseiu Tuberculosis\n145 Derau Sh Buffalo\n(Specify for which of the following services you wish to be considered.)\n20. War service, wherever needed\nWhen available\n1mo notice\nny\nyes\nAre you willing to take the oath of allegiance?\n21. Instructor, Elementary Hygiene\nyes\n22. Public Health Nursing yes In Town and Country Nursing, Service\n23.\nName and permanent address of nearest relative Mrs Er J. or for War Service\n744 ask Caud are Buffalo\nScreency\nDate floo 27-1918\nSignature of Nurse Julia Catherine L.Smith\nTo the Committee:\nC. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval\n703. This blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, 29 and A. R.\nand warded endorsement by Local Committee, with credentials (Form 3 and 4), together with Forms 10, 11 and 29, should be for-\nWashington, D. C.\nthrough the Director of the Bureau of Nursing in your Division to the Department of Nursing, American Red Cross,\nIn case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the\nLocal Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the\nLocal Committee, from whence credentials will be procured.\n(SEE OTHER SIDE)"
}