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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-24-36.
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1. Name of applicant in full
Rabina May Walters
If married, give maiden name
2. Permanent address in full
3029 Fourth AVE WEST SEATLY WN.
Probable
address for one year 325 D. Dewistero It Louis Mr.r
34 3.
Date of birth. DECEMBER this 995 Race White Place of birth DALLAS, TEXAS
(Month)
(Day)
(Year)
Birthplace of father u.s A
Mother SCOTLAND Citizenship of father AMERICAN
Are you a citizen of the United States?
YES
4.
Are you single, married, a widow, or divorced?
SINGLE
5. How many years have you attended Grammar School? 8 High school? 4 Normal school?
Private school?
College? 3 If tutored privately, name subjects covered and length
of time
6. What languages other than English do you speak?
(Underline those which you speak fluently)
7.
Occupation before entering school of nursing STUDENT
8.
From what school of nursing did you receive your diploma? Mc PHERSON County Hospital
City and State PHERSON, KANSAS Date of graduation
7-6-26
9. Character of Hospital: General?
V
Special?
Private?
10. Did your training include medical and surgical care of men ? yes Of women? YES
Pediatrics? YES Obstetrics? YES Communicable diseases? yes
11. Daily average number of patients in hospital during training to26 Length of course 3yrs
12. Name and address of director of school of nursing under whom you received training
DENA GRONEWALD
13. If your education as a nurse was received in more than one hospital, give name, location and
time
spent in each Me Pherson Hospital 2 YRS. 8 Mo. CHiLDRENS MERC Nosp.
KANSAS City Mo.
14. Are you a member of your Alumnae Association? YES
4mo
15.
Are you affiliated with the American Nurses' Association through membership in District and
State Associations?
YES
Affiliation with the American Nurses' Association means active membership in a District and Graduate Nurses' Association.
16.
Give name and address of secretary of the District or State Association of which you are a
member
MORGAGET ALLARD - 4543 WESTMINISTER Place
Mo,
SEPTI93
3881
17. Are you a registered nurse YES In what of registration.i9.3% Number S-732
18. Type of work and length of service since graduation:
Private Duty 1yu. 3 SAIUT Louis Disiting Nurse Assoc, \ lyu.
School Nurse ENID City Schools ENID, OtslA 2 yrs
visiting NURSE STAFF IYR.
Past " 11 Seartle PACiFic College SeaMLE, WN 3yrs.
V.N.A. OF STLAUIZ
Out PATICIT Dept Ha R/Do R w ew Hospi TA SeAttLE
GRADUATE NURSiNg Supervision University WASHINGTON HARBORVIEW Division
19.
Are you willing to accept service if the United States becomes involved in war?
YES
Or, service with the American Red Cross in time of disaster or great emergency? YES
Check to indicate whether you would prefer assignment with the Army Nurse Corps
X
or Navy Nurse Corps
20. Are you willing to take the oath of allegiance?
YES
21.
Are you a qualified public health nurse, or teacher?
YES
If so, please answer the questions on the reverse side of this blank.
22.
Give name and permanent address of nearest relative or friend, residing in the United States
(state relationship).
MRS MARjaRY WALTERS 3029 Faurth AVE WEST, SEATHE, WN.
Date JUNE: 1939
Signature of Nurse Rabina Walters
*Addresses must be given in full, including street, city and state.
(OVER)
Jr. Schire corresp not m fele - affil increase ett love m1932
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"ocrText": "THE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-24-36.\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1. Name of applicant in full\nRabina May Walters\nIf married, give maiden name\n2. Permanent address in full\n3029 Fourth AVE WEST SEATLY WN.\nProbable\naddress for one year 325 D. Dewistero It Louis Mr.r\n34 3.\nDate of birth. DECEMBER this 995 Race White Place of birth DALLAS, TEXAS\n(Month)\n(Day)\n(Year)\nBirthplace of father u.s A\nMother SCOTLAND Citizenship of father AMERICAN\nAre you a citizen of the United States?\nYES\n4.\nAre you single, married, a widow, or divorced?\nSINGLE\n5. How many years have you attended Grammar School? 8 High school? 4 Normal school?\nPrivate school?\nCollege? 3 If tutored privately, name subjects covered and length\nof time\n6. What languages other than English do you speak?\n(Underline those which you speak fluently)\n7.\nOccupation before entering school of nursing STUDENT\n8.\nFrom what school of nursing did you receive your diploma? Mc PHERSON County Hospital\nCity and State PHERSON, KANSAS Date of graduation\n7-6-26\n9. Character of Hospital: General?\nV\nSpecial?\nPrivate?\n10. Did your training include medical and surgical care of men ? yes Of women? YES\nPediatrics? YES Obstetrics? YES Communicable diseases? yes\n11. Daily average number of patients in hospital during training to26 Length of course 3yrs\n12. Name and address of director of school of nursing under whom you received training\nDENA GRONEWALD\n13. If your education as a nurse was received in more than one hospital, give name, location and\ntime\nspent in each Me Pherson Hospital 2 YRS. 8 Mo. CHiLDRENS MERC Nosp.\nKANSAS City Mo.\n14. Are you a member of your Alumnae Association? YES\n4mo\n15.\nAre you affiliated with the American Nurses' Association through membership in District and\nState Associations?\nYES\nAffiliation with the American Nurses' Association means active membership in a District and Graduate Nurses' Association.\n16.\nGive name and address of secretary of the District or State Association of which you are a\nmember\nMORGAGET ALLARD - 4543 WESTMINISTER Place\nMo,\nSEPTI93\n3881\n17. Are you a registered nurse YES In what of registration.i9.3% Number S-732\n18. Type of work and length of service since graduation:\nPrivate Duty 1yu. 3 SAIUT Louis Disiting Nurse Assoc, \\ lyu.\nSchool Nurse ENID City Schools ENID, OtslA 2 yrs\nvisiting NURSE STAFF IYR.\nPast \" 11 Seartle PACiFic College SeaMLE, WN 3yrs.\nV.N.A. OF STLAUIZ\nOut PATICIT Dept Ha R/Do R w ew Hospi TA SeAttLE\nGRADUATE NURSiNg Supervision University WASHINGTON HARBORVIEW Division\n19.\nAre you willing to accept service if the United States becomes involved in war?\nYES\nOr, service with the American Red Cross in time of disaster or great emergency? YES\nCheck to indicate whether you would prefer assignment with the Army Nurse Corps\nX\nor Navy Nurse Corps\n20. Are you willing to take the oath of allegiance?\nYES\n21.\nAre you a qualified public health nurse, or teacher?\nYES\nIf so, please answer the questions on the reverse side of this blank.\n22.\nGive name and permanent address of nearest relative or friend, residing in the United States\n(state relationship).\nMRS MARjaRY WALTERS 3029 Faurth AVE WEST, SEATHE, WN.\nDate JUNE: 1939\nSignature of Nurse Rabina Walters\n*Addresses must be given in full, including street, city and state.\n(OVER)\nJr. Schire corresp not m fele - affil increase ett love m1932"
}