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D M R 1
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
Jog
1. Name of applicant in full Yssabilla Gertrude Waters
father
for reval months
Temporary 174 So. Goodman St. Rochester, new York.
2. Address in full
3
Permanent
57
3. Date of birth Feb.22,1862
Race White
Place of Birth Groton, massachusetts
Birthplace of father microlary, mass Mother Groton,mass. Citizenship of father american
4. Are you married, single widow? single Are you a citizen of the United States? Yes-
or a
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no
Are you physically strong and healthy? Yes.
6. How many years have you attended grammar school?
4
High school ? 4
Normal school ?
Private school?
College?
If tutored privately, name subjects covered and length of time Forgorten he
time- Englishditureters, algera, Generty History Latin, Frever German
7. What languages other than English do you speak? a every little (Underline German those which you
speak fluently)
8. Occupation before entering training school
nour
9.
ok
From what hospital training school did you receive your diploma? John Hop Kims Hospital
City and state Baltimere, maryland, Date
ofgraduation June 1897
Give name at time of graduation Yssabrea Gertrude Waters.
10. Character of Hospital General ? Yes-
Special ?
Private?
11. Did your training include obstetrics? Yes Care of men ? Yes Children? Yes Contagious diseases? Yes
12. of
course month in obsterries
Daily average and number 22 patients in hospital during training about 300 Length of course years regular
13. Name and address of superintendent of training school under whom you received training? miss m adelaids hutting
Prof. thursingand H cath, Teachers evellege, Columbia University, new) York ing
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
15. Of what nursing organizations are you a member? Juhus opkins neuses alumne assa
Tenatimal Organizatinsfor Public Health nursing, Life member amkRed Crise.
16. Which, if any, is affiliated with the American Nurses Association? alumnae asso-
17. Give name and address of secretary of at least one of these organizations min Crandall, 156-5"an.ExSec -
n.e.P.H.N.
(Think)
on
18. Are you a registered nurse? Yes
In what state? new York(Date of registration 1904 Number
19. How and where employed since graduation
Give dates with months
Name and address of employers:
Henry St Satement n.4. City Je15-Angl,
Shanish american warus tuba any 1898 Je 1899
Igans United States my service Gerermanh.
-
Henryth Settlement
Je1899- 1912
Igan myservices
national By for Pub-Health Aumy n.y. 1912- - 1917 farthing
"
or
&
quiting statestus an Public Health activities
Island Possessions to The present time
Lenghunt he U.S.and
(Present position) nour
20.
Check services in which you are willing to serve and underscore one preferred. I am too old for special
(a)
War Service service Incase of need will do what Dam able to do-
Wherever needed.
Marine Hospitals
(b) Public Health War Service: Sanitary Zones. Wherever needed.
Public Health Nursing in Town and Country Nursing Service.
21. Upon what date will you be available for service?
22. Are you willing to take the oath of allegiance? Yes-
23. Name and permanent address of nearest relative adupted mice- mis Frank E. Brown
100 Germantan, Pa.
Date march31, 1919
Signature of nurse Yssabrela Girtrude Waters -
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, and A. R. C. 703.
Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorse-
ment by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 29 and 11, should be forwarded through the
Director of the Bureau of Nursing in your Division Office to the 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 Com-
mittee, from whence credentials will be procured.
NOTE.-Nurses who have had training or experience in Public Health Nursing will, in addition to
the above, fill out questions 24 to 31 on reverse side of this blank.
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"ocrText": "D M R 1\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)\nJog\n1. Name of applicant in full Yssabilla Gertrude Waters\nfather\nfor reval months\nTemporary 174 So. Goodman St. Rochester, new York.\n2. Address in full\n3\nPermanent\n57\n3. Date of birth Feb.22,1862\nRace White\nPlace of Birth Groton, massachusetts\nBirthplace of father microlary, mass Mother Groton,mass. Citizenship of father american\n4. Are you married, single widow? single Are you a citizen of the United States? Yes-\nor a\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no\nAre you physically strong and healthy? Yes.\n6. How many years have you attended grammar school?\n4\nHigh school ? 4\nNormal school ?\nPrivate school?\nCollege?\nIf tutored privately, name subjects covered and length of time Forgorten he\ntime- Englishditureters, algera, Generty History Latin, Frever German\n7. What languages other than English do you speak? a every little (Underline German those which you\nspeak fluently)\n8. Occupation before entering training school\nnour\n9.\nok\nFrom what hospital training school did you receive your diploma? John Hop Kims Hospital\nCity and state Baltimere, maryland, Date\nofgraduation June 1897\nGive name at time of graduation Yssabrea Gertrude Waters.\n10. Character of Hospital General ? Yes-\nSpecial ?\nPrivate?\n11. Did your training include obstetrics? Yes Care of men ? Yes Children? Yes Contagious diseases? Yes\n12. of\ncourse month in obsterries\nDaily average and number 22 patients in hospital during training about 300 Length of course years regular\n13. Name and address of superintendent of training school under whom you received training? miss m adelaids hutting\nProf. thursingand H cath, Teachers evellege, Columbia University, new) York ing\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\n15. Of what nursing organizations are you a member? Juhus opkins neuses alumne assa\nTenatimal Organizatinsfor Public Health nursing, Life member amkRed Crise.\n16. Which, if any, is affiliated with the American Nurses Association? alumnae asso-\n17. Give name and address of secretary of at least one of these organizations min Crandall, 156-5\"an.ExSec -\nn.e.P.H.N.\n(Think)\non\n18. Are you a registered nurse? Yes\nIn what state? new York(Date of registration 1904 Number\n19. How and where employed since graduation\nGive dates with months\nName and address of employers:\nHenry St Satement n.4. City Je15-Angl,\nShanish american warus tuba any 1898 Je 1899\nIgans United States my service Gerermanh.\n-\nHenryth Settlement\nJe1899- 1912\nIgan myservices\nnational By for Pub-Health Aumy n.y. 1912- - 1917 farthing\n\"\nor\n&\nquiting statestus an Public Health activities\nIsland Possessions to The present time\nLenghunt he U.S.and\n(Present position) nour\n20.\nCheck services in which you are willing to serve and underscore one preferred. I am too old for special\n(a)\nWar Service service Incase of need will do what Dam able to do-\nWherever needed.\nMarine Hospitals\n(b) Public Health War Service: Sanitary Zones. Wherever needed.\nPublic Health Nursing in Town and Country Nursing Service.\n21. Upon what date will you be available for service?\n22. Are you willing to take the oath of allegiance? Yes-\n23. Name and permanent address of nearest relative adupted mice- mis Frank E. Brown\n100 Germantan, Pa.\nDate march31, 1919\nSignature of nurse Yssabrela Girtrude Waters -\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, and A. R. C. 703.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorse-\nment by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 29 and 11, should be forwarded through the\nDirector of the Bureau of Nursing in your Division Office to the 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 Local\nCommittee, instead of to Washington as instructed, such forms should be forwarded at once to Washington by the Local Com-\nmittee, from whence credentials will be procured.\nNOTE.-Nurses who have had training or experience in Public Health Nursing will, in addition to\nthe above, fill out questions 24 to 31 on reverse side of this blank."
}