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DMRI
THE AMERICAN RED CROSS
NURSING SERVICE
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
1. Name of applicant in full Hattie O. Wilson
2. Address in full, Street 28 E. mill SL- City Plymouth State Wisconsin
3. Date of birth Oct 25-1873
Place of birth Rolla- mo -
4. Are you married, single or a widow?
single
Are you citizen of the United States? yes
a
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no
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 attended Public school at Red Oak Iowa
7. What languages other than English do you speak? german
two years private german school shebrygaw
8. Occupation before entering training school
none
9. From what hospital training school did you receive your diploma? Lakeside Hospital
City and state $ heboygan wise -
Date of graduation Sept-1896
10. Character of hospital: General?
Just
Special?
Private?
11. Did your training include obstetrics? yes Care of men? yes Children yes Contagious diseases? yes
12. Daily average number of patients in hospital during training
r/
Length of course Two years
13. Name and address of superintendent of training school under whom you received training miss Knapp died
Dr. Human Runeking Supt of nursis -
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
6 months milwaukee Co Hospital prior to entering Lokiside Hospital
15. Of what nursing organizations are you a member?
Saskatchewan Registered nurses association-cauada
16. any, Nurses
Which, if is affiliated with the American Association Do not know
17. Give name and address of secretary of at least one of these organizations
18. Are you a registered nurse? yes In what state? wise Date of registration 21-1914 Number 836
Mrs E It Vaw Vackewburg Regina $ 'asle - april Canada
19. How and where employed since graduation:
Give dates with months.
Name and address of employers:
From / 896 2.1912 private nursing in mise and see -
Oct 151912 hospit Oct 15-1911- april 1579 mays Broo Rochester min
4 mo special
2" 11 with nissa many times Ausesthetist in Dr. wan mayo's openting morn
about 10 years country surgical corls for Dr. a.r. $icker Franklin Wise
Hospital surgical cases
for
Dr.a. gentic S heboygan me RR29
also my share (Specify of med. for which cases of the following for services all m. you D; wish =past considered.) year charge g Scotia at Hospital more Jam
to be
20. War service, wherever needed
yes
Are you willing to take the oath of allegiance?
yrs-
When available July / 1918 exista
21. Instructor, Elementary Hygiene
22. Public Health Nursing
In Town and Country Nursing Service
-
P
or for War Service yes
23. Name and permanent address of nearest relative
John
Wilson
28. E. mill & true
mic-
Date June 3-1918
Signature of Nurse Hattie O. milson
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 en-
dorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10 and 11, should be forwarded to the
Chairman, National Committee on Nursing Service, 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.
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"ocrText": "DMRI\nTHE AMERICAN RED CROSS\nNURSING SERVICE\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1. Name of applicant in full Hattie O. Wilson\n2. Address in full, Street 28 E. mill SL- City Plymouth State Wisconsin\n3. Date of birth Oct 25-1873\nPlace of birth Rolla- mo -\n4. Are you married, single or a widow?\nsingle\nAre you citizen of the United States? yes\na\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no\nAre you physically strong and healthy\nyes -\n6. Name educational institutions attended before entering training school, stating number of years at each and from which\nyou were graduated attended Public school at Red Oak Iowa\n7. What languages other than English do you speak? german\ntwo years private german school shebrygaw\n8. Occupation before entering training school\nnone\n9. From what hospital training school did you receive your diploma? Lakeside Hospital\nCity and state $ heboygan wise -\nDate of graduation Sept-1896\n10. Character of hospital: General?\nJust\nSpecial?\nPrivate?\n11. Did your training include obstetrics? yes Care of men? yes Children yes Contagious diseases? yes\n12. Daily average number of patients in hospital during training\nr/\nLength of course Two years\n13. Name and address of superintendent of training school under whom you received training miss Knapp died\nDr. Human Runeking Supt of nursis -\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\n6 months milwaukee Co Hospital prior to entering Lokiside Hospital\n15. Of what nursing organizations are you a member?\nSaskatchewan Registered nurses association-cauada\n16. any, Nurses\nWhich, if is affiliated with the American Association Do not know\n17. Give name and address of secretary of at least one of these organizations\n18. Are you a registered nurse? yes In what state? wise Date of registration 21-1914 Number 836\nMrs E It Vaw Vackewburg Regina $ 'asle - april Canada\n19. How and where employed since graduation:\nGive dates with months.\nName and address of employers:\nFrom / 896 2.1912 private nursing in mise and see -\nOct 151912 hospit Oct 15-1911- april 1579 mays Broo Rochester min\n4 mo special\n2\" 11 with nissa many times Ausesthetist in Dr. wan mayo's openting morn\nabout 10 years country surgical corls for Dr. a.r. $icker Franklin Wise\nHospital surgical cases\nfor\nDr.a. gentic S heboygan me RR29\nalso my share (Specify of med. for which cases of the following for services all m. you D; wish =past considered.) year charge g Scotia at Hospital more Jam\nto be\n20. War service, wherever needed\nyes\nAre you willing to take the oath of allegiance?\nyrs-\nWhen available July / 1918 exista\n21. Instructor, Elementary Hygiene\n22. Public Health Nursing\nIn Town and Country Nursing Service\n-\nP\nor for War Service yes\n23. Name and permanent address of nearest relative\nJohn\nWilson\n28. E. mill & true\nmic-\nDate June 3-1918\nSignature of Nurse Hattie O. milson\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 en-\ndorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10 and 11, should be forwarded to the\nChairman, National Committee on Nursing Service, 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."
}