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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)
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
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- Size
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Document data
- ID
- 2662273
- Core
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- Type
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DTO data
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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)"
}