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DMR1
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
2. Address in full Street 4, n. Preston of City Phila
1. Name of applicant in full I whis Sunder .
State Penna
3. Date of birth Dec. 11th 1874
Place of birth Phila. Penna
4. Are you married, single or a widow? Single
Are you a citizen of the no United States? Yes
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
Are you physically strong and healthy?
yes
6. Name educational institutions attended before entering training school, stating number of years at each and from
which you were graduated Phila. Public schools. Rights Trade.
7.
8. Occupation before entering training school Henographer Editorial dept Saturday Evening Post.
What languages other than English do you speak? none- but have beging Frends lessons
9.
City and state Phila Pa.
From what hospital training school did you receive your diploma? bhildrens Homeopathic Phila-
Date of graduation June 1906
10.
Character of hospital: General? general Special bhildrens
Put
Private?
11. Did your training include obstetrics yes
Care
of
men?
yes.
Children
120
eyes
Contagious
diseases?
no
12. Daily average number of patients in hospital during training
Length of course 2yes. 3 mo.
13. Name and address of superintendent of training school under whom you received training thing
Kashami
Johnsom - Home for Incurates. 48 Moodland are Phila Pa Orst traduck
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
bouse if 6 moom allegheny General Hosp Pitsfurg Pa.
Public Health nurses. also. Phila-Pa-
15. Of what nursing organizations are you a member? alumili bhild. Hobreoposhis. Hrsf.
Both
-
16. Which, if any, is affiliated with the American Nurses Association?
I think
17. Give name and address of secretary of at least one of these organizations mrs. L. Roinstock
br. 3124 t sto. Phila- Alumni bhildrens Homeo-Hosp.
18. Are you a registered nurse? yes In what state Penna Date of registration 1/8/1910 Number - 594
19. How and where employed since graduation :
Give dates with months.
Name and address of employers
Some prink hursing
4906-1907-1908-
Hahneman Hosp. Head hurse
this Era. food Halmeman Hosp
muses. Support Juny way Hosp. Springtake n.f.
In June ackemam g.
Yess Phila. Ser Homes Hop Supt
I.H.M. Gay -1687 4.54 1st Phila
Ghila Publis Schyol hurse
Sept 1913-be 1917Miss Kashaine Johnson 15th Mila
Presty Hrap Social Service
childrens lept -
Dec. 1916- still there 11/29/18- Miss Francis Hosketter Thesty ss. Phila
(Specify for which of the following services you wish to be considered.)
20. War service, wherever needed
When available September 16th 1918.
Are you willing to take the oath of allegiance?
Instructor, Elementary build. Hygiene Melfare. inflance .
Yes
21.
22. Public Health Nursing
In Town and Country Nursing Service
or for War Service
23.
Name and permanent address of nearest relative bousing Mrs. Percival Straus
6012 norm St-Germanton Phila.
Date im Jones 291 1918
Signature of Nurse Julies Singder
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, 29, and A. R. C.
703. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval
and endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 11 and 29, should be
for-
warded to the Chairman, Department of Nursing, 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 Committee. from whence credentials will be procured.
1M I-May
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"ocrText": "DMR1\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n2. Address in full Street 4, n. Preston of City Phila\n1. Name of applicant in full I whis Sunder .\nState Penna\n3. Date of birth Dec. 11th 1874\nPlace of birth Phila. Penna\n4. Are you married, single or a widow? Single\nAre you a citizen of the no United States? Yes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nAre you physically strong and healthy?\nyes\n6. Name educational institutions attended before entering training school, stating number of years at each and from\nwhich you were graduated Phila. Public schools. Rights Trade.\n7.\n8. Occupation before entering training school Henographer Editorial dept Saturday Evening Post.\nWhat languages other than English do you speak? none- but have beging Frends lessons\n9.\nCity and state Phila Pa.\nFrom what hospital training school did you receive your diploma? bhildrens Homeopathic Phila-\nDate of graduation June 1906\n10.\nCharacter of hospital: General? general Special bhildrens\nPut\nPrivate?\n11. Did your training include obstetrics yes\nCare\nof\nmen?\nyes.\nChildren\n120\neyes\nContagious\ndiseases?\nno\n12. Daily average number of patients in hospital during training\nLength of course 2yes. 3 mo.\n13. Name and address of superintendent of training school under whom you received training thing\nKashami\nJohnsom - Home for Incurates. 48 Moodland are Phila Pa Orst traduck\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nbouse if 6 moom allegheny General Hosp Pitsfurg Pa.\nPublic Health nurses. also. Phila-Pa-\n15. Of what nursing organizations are you a member? alumili bhild. Hobreoposhis. Hrsf.\nBoth\n-\n16. Which, if any, is affiliated with the American Nurses Association?\nI think\n17. Give name and address of secretary of at least one of these organizations mrs. L. Roinstock\nbr. 3124 t sto. Phila- Alumni bhildrens Homeo-Hosp.\n18. Are you a registered nurse? yes In what state Penna Date of registration 1/8/1910 Number - 594\n19. How and where employed since graduation :\nGive dates with months.\nName and address of employers\nSome prink hursing\n4906-1907-1908-\nHahneman Hosp. Head hurse\nthis Era. food Halmeman Hosp\nmuses. Support Juny way Hosp. Springtake n.f.\nIn June ackemam g.\nYess Phila. Ser Homes Hop Supt\nI.H.M. Gay -1687 4.54 1st Phila\nGhila Publis Schyol hurse\nSept 1913-be 1917Miss Kashaine Johnson 15th Mila\nPresty Hrap Social Service\nchildrens lept -\nDec. 1916- still there 11/29/18- Miss Francis Hosketter Thesty ss. Phila\n(Specify for which of the following services you wish to be considered.)\n20. War service, wherever needed\nWhen available September 16th 1918.\nAre you willing to take the oath of allegiance?\nInstructor, Elementary build. Hygiene Melfare. inflance .\nYes\n21.\n22. Public Health Nursing\nIn Town and Country Nursing Service\nor for War Service\n23.\nName and permanent address of nearest relative bousing Mrs. Percival Straus\n6012 norm St-Germanton Phila.\nDate im Jones 291 1918\nSignature of Nurse Julies Singder\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, 29, and A. R. C.\n703. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval\nand endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 11 and 29, should be\nfor-\nwarded to the Chairman, Department of Nursing, 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\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.\n1M I-May"
}