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FORM 1219
For Off , use
III
REV,AUG. 1941
Date Auth
AMERICAN RED CROSS
Type of Auth
HARVARD UNIT
11)
Chapter
APPLICATION FORM
was moltasinagio to
State
PUBLIC HEALTH NURSE
Confidential
and
REDxCROSSxMOMEXNURSINO XINS TRUCTOR
Please return
Date
March 27, 1942
I. PERSONAL
Badge (No. 41828
Storey., Miss Marjory
(H.D
Name in full
(MISS OR MRS)
(IF MARRIED, GIVE MAIDEN NAME)
Not enrolled
Present address
411 west ll6th St., New York, N.Y. Tel. No. Univ.3.400
(CITY)
(STATE)
TO
(STREET)
30 Hortense St., Rochester, N.Y. Tel. No. Genesee 4774
Permanent address
quozo
(STREET)
ejaja
(CITY)
(STATE)
Marital status Single
38010
bell
Date of
birth June 11,1898
(ÄINGLE, MARRIED WIDOWED, DIVORCED)
Citizenship
United States Citizen
Race White
II. EDUCATION
1. Prior to entering school of nursing
of
Diploma
Name
City and State
Dates
or Degree
Major
88010
High School West High School Rochester N.Y.. 1913-191.7 Dinloma
history &
Normal School
Economics
or University University of Rochester
1917-1921
B.A.
Rochester, N.Y.
Other
20
2. School of nursing from which you graduated
Name Highland Hospital School of Nursing
Location Rochester. J.Y.
Date of graduation 19.24
Length of course 2 mo.
(CITY AND STATE)
3. Undergraduate affiliations
favad
ob
Sediviss a belli Length of
Hospital or Organization
City and State
Type
time spent
Public Health Nursing Asan. Bochester. N.Y.. Public Health
4 montths
ovah
4. Academic study since graduation from school of nursing
College or University or
Diploma
postgraduate course
City and State No. Months or Degree
Major
3 18mack
TEaching in Publer
Enrolled in (1942)
Heafth Durring
gupe aniversity - Extension
new Haven.com (4hr)
de Rachester n.y.
The
What courses in principles of teaching have you had? university of Rechistor - Educational
Have you had a course in práctice teaching? no
Psychology Principles of Teaching
Do you hold a state teacher's certificate?
no
Where
Do you speak a foreign language?
no
(Over)
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"ocrText": "FORM 1219\nFor Off , use\nIII\nREV,AUG. 1941\nDate Auth\nAMERICAN RED CROSS\nType of Auth\nHARVARD UNIT\n11)\nChapter\nAPPLICATION FORM\nwas moltasinagio to\nState\nPUBLIC HEALTH NURSE\nConfidential\nand\nREDxCROSSxMOMEXNURSINO XINS TRUCTOR\nPlease return\nDate\nMarch 27, 1942\nI. PERSONAL\nBadge (No. 41828\nStorey., Miss Marjory\n(H.D\nName in full\n(MISS OR MRS)\n(IF MARRIED, GIVE MAIDEN NAME)\nNot enrolled\nPresent address\n411 west ll6th St., New York, N.Y. Tel. No. Univ.3.400\n(CITY)\n(STATE)\nTO\n(STREET)\n30 Hortense St., Rochester, N.Y. Tel. No. Genesee 4774\nPermanent address\nquozo\n(STREET)\nejaja\n(CITY)\n(STATE)\nMarital status Single\n38010\nbell\nDate of\nbirth June 11,1898\n(ÄINGLE, MARRIED WIDOWED, DIVORCED)\nCitizenship\nUnited States Citizen\nRace White\nII. EDUCATION\n1. Prior to entering school of nursing\nof\nDiploma\nName\nCity and State\nDates\nor Degree\nMajor\n88010\nHigh School West High School Rochester N.Y.. 1913-191.7 Dinloma\nhistory &\nNormal School\nEconomics\nor University University of Rochester\n1917-1921\nB.A.\nRochester, N.Y.\nOther\n20\n2. School of nursing from which you graduated\nName Highland Hospital School of Nursing\nLocation Rochester. J.Y.\nDate of graduation 19.24\nLength of course 2 mo.\n(CITY AND STATE)\n3. Undergraduate affiliations\nfavad\nob\nSediviss a belli Length of\nHospital or Organization\nCity and State\nType\ntime spent\nPublic Health Nursing Asan. Bochester. N.Y.. Public Health\n4 montths\novah\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\npostgraduate course\nCity and State No. Months or Degree\nMajor\n3 18mack\nTEaching in Publer\nEnrolled in (1942)\nHeafth Durring\ngupe aniversity - Extension\nnew Haven.com (4hr)\nde Rachester n.y.\nThe\nWhat courses in principles of teaching have you had? university of Rechistor - Educational\nHave you had a course in práctice teaching? no\nPsychology Principles of Teaching\nDo you hold a state teacher's certificate?\nno\nWhere\nDo you speak a foreign language?\nno\n(Over)"
}