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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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55
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Page context
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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."
}