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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON. D. c.
Miss Eva Louise Smythe,
40 Passaic Street,
Hackensack, N.J.
1940
2
QUESTIONNAIRES
DESTROYED
Dear Red Cross Nurse:
9-11-45
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
C.M. Monrad, R.N.,
Chairman or
Nurses should report at once to the
88 Clifton Place,
Secretary.
Secretary of the Local Committee under
Jersey City,N.J.
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full
Cra Louise Singthe
If married, give husband's name
Permanent address 40 Passaic ft (STREET, ETC.) Hacksmark (CITY) Bergess (COUNTY) (STATE) n.J.
Probable address for the next year
40 Passaic St Heachmark's
(STREET, ETC.)
Telephone No. Hack. 2-609680 Heachensack (CITY) Bergen (COUNTY) n.J (STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
This gracem miller, 40 Passaic It. backs mark. n.J
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
no
Have you ever been? yes Would you like to teach Red Cross classes?
mo
Indicate present physical condition
Excellent
Would respond emergency epidemic, disaster, war, you
you to an call in event of etc.?
Badge No. 11,891
Current date mar. 1940
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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"ocrText": "FORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON. D. c.\nMiss Eva Louise Smythe,\n40 Passaic Street,\nHackensack, N.J.\n1940\n2\nQUESTIONNAIRES\nDESTROYED\nDear Red Cross Nurse:\n9-11-45\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nC.M. Monrad, R.N.,\nChairman or\nNurses should report at once to the\n88 Clifton Place,\nSecretary.\nSecretary of the Local Committee under\nJersey City,N.J.\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full\nCra Louise Singthe\nIf married, give husband's name\nPermanent address 40 Passaic ft (STREET, ETC.) Hacksmark (CITY) Bergess (COUNTY) (STATE) n.J.\nProbable address for the next year\n40 Passaic St Heachmark's\n(STREET, ETC.)\nTelephone No. Hack. 2-609680 Heachensack (CITY) Bergen (COUNTY) n.J (STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nThis gracem miller, 40 Passaic It. backs mark. n.J\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno\nHave you ever been? yes Would you like to teach Red Cross classes?\nmo\nIndicate present physical condition\nExcellent\nWould respond emergency epidemic, disaster, war, you\nyou to an call in event of etc.?\nBadge No. 11,891\nCurrent date mar. 1940\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}