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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 2-4-35.
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1.
Name
of applicant in full Jeanie Lees Adkersou
If married, give maiden name
2.
Permanent address in full. 1228 stau hope ave- Richmond vo
Probable address for one year same
3.
Date of birth Octaber 8th 1902 Race W
Place of birth South Boston va
Birthplace of father (Month) Halifax (Day) Co Us Mother of father Omes
(Year)
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? .7 .High school?
Normal school?
courses.
Private school? 4 College?.& If tutored privately, name subjects covered and length
of
time. High School education abtained in Private school
-
6.
What languages other than English do you speak? none
(Underline those which you speak fluently)
7. Occupation before entering school of nursing none
8. From what school of nursing did you receive your diploma? stuart Circle Hoop
City and State Richmand va
Date of graduation Feb. 21st 1927
9. Character of Hospital: General?
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. 80 Length of course 3 yrs. -
12. Name and address of director of school of nursing under whom you received training
miss Charlatte Phiffer stuart Circle two pital Richmond ve
13. If your education as a nurse was received in more than one hospital, give name, location and
time spent in each Children's Hosp of Philadelphia 6 wks -
14.
Are you a member of your Alumnae Association? yes
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 the District and Graduate Nurses' Associations
of the state in which you are living at the present time.
16. Give name and address of secretary of the District or State Association of which you are a
17.
Are you a registered nurse? yes In what State? Ve Date of registration Mari Number 2197
member Mrs. Jane Wetzel Farris 3015 6. Broad 5-1927
18. Type of work and length of service since graduation:
Supervisor med + Surq floor stuart Circle Hosp 18 months
S?
staff nurse I.V. na Richmond Va 7 years
sa SU OL araço Aont surg exbezieuco
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
20. Are you willing to take the oath of allegiance? yes
21. Are you a qualified public health nurse, or teacher?
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
Cartiale F Adkerson. Boonsbare Rd. - hynchburg Va (Brother)
(state relationship),
Date 3-13-36
Signature of Nurse Jeanie hees adkuran
5,
(OVER)
6
5
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"ocrText": "D\na\nK\n&\ng\ns\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 2-4-35.\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1.\nName\nof applicant in full Jeanie Lees Adkersou\nIf married, give maiden name\n2.\nPermanent address in full. 1228 stau hope ave- Richmond vo\nProbable address for one year same\n3.\nDate of birth Octaber 8th 1902 Race W\nPlace of birth South Boston va\nBirthplace of father (Month) Halifax (Day) Co Us Mother of father Omes\n(Year)\nAre you a citizen of the United States? yes\n4.\nAre you single, married, a widow, or divorced? single\n5. How many years have you attended Grammar School? .7 .High school?\nNormal school?\ncourses.\nPrivate school? 4 College?.& If tutored privately, name subjects covered and length\nof\ntime. High School education abtained in Private school\n-\n6.\nWhat languages other than English do you speak? none\n(Underline those which you speak fluently)\n7. Occupation before entering school of nursing none\n8. From what school of nursing did you receive your diploma? stuart Circle Hoop\nCity and State Richmand va\nDate of graduation Feb. 21st 1927\n9. Character of Hospital: General?\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. 80 Length of course 3 yrs. -\n12. Name and address of director of school of nursing under whom you received training\nmiss Charlatte Phiffer stuart Circle two pital Richmond ve\n13. If your education as a nurse was received in more than one hospital, give name, location and\ntime spent in each Children's Hosp of Philadelphia 6 wks -\n14.\nAre you a member of your Alumnae Association? yes\n15. Are you affiliated with the American Nurses' Association through membership in District and\nState Associations? yes\nAffiliation\nwith the American Nurses' Association means active membership in the District and Graduate Nurses' Associations\nof the state in which you are living at the present time.\n16. Give name and address of secretary of the District or State Association of which you are a\n17.\nAre you a registered nurse? yes In what State? Ve Date of registration Mari Number 2197\nmember Mrs. Jane Wetzel Farris 3015 6. Broad 5-1927\n18. Type of work and length of service since graduation:\nSupervisor med + Surq floor stuart Circle Hosp 18 months\nS?\nstaff nurse I.V. na Richmond Va 7 years\nsa SU OL araço Aont surg exbezieuco\n19.\nAre you willing to accept service if the United States becomes involved in war? yes\nOr, service with the American Red Cross in time of disaster or great emergency? yes\n20. Are you willing to take the oath of allegiance? yes\n21. Are you a qualified public health nurse, or teacher?\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\nCartiale F Adkerson. Boonsbare Rd. - hynchburg Va (Brother)\n(state relationship),\nDate 3-13-36\nSignature of Nurse Jeanie hees adkuran\n5,\n(OVER)\n6\n5"
}