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Form 1037
Rev. 3-1-25
THE AMERICAN NATIONAL 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 Sena Andersen
2. Address in
full f 901 Henry Street, neenah, Wisconsin
3) 3. Date Birthplace of birth of father may Denmark 24, 1895 Mother Race Denmark White Place of birth Citizenship neenah, of father Wisconsin U.S.
4. Are you married, single or a widow? Single Are you a citizen of the United States? yes
5. How many years have you attended grammar school? 8 High school? 4 Normal school? 2
Private school?
College? It If tutored privately, name subjects covered and length of time
6. you
What languages other than English do speak? Danish German
(Underline those which you speak fluently.)
7.
Occupation before entering training school Teaching Public Schools
8.
From what hospital training school did you receive your diploma? St. mary Hospital
City and State Rochester minnesstapste of graduation
Sena Andersen
June 1922
Give name at time of graduation
9. Character of hospital: General? general Special?
Private?
10. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? yes
11.1 Daily average number of patients in hospital during training 600
Length
of
course
3
years
12. Name and address of superintendent of nurses under whom you received training
Sister Diomying, St. marip Hospital- Rochester. minnesota.
13.
If your training as a nurse was received in more than one hospital, give name, location and time spent in each
City County Hosp., St.Paul. minn. 8 months,
14. Of what nursing organizations are you a member? not nurses organization
alumni St. marip Hosp-Rochector, min. not Qug for Public Health Mus.
15. Which, if any, is affiliated with the American Nurses' Association?
16. Give name and address of secretary of at least one of these organizations mins anna Fetterson
370-7th.am. new York city
newyork.
oct.1925 number - 24751
17. Are you a registered nurse? yes in what State? minnesis Date of registration here 1922 Number - 4574
18. Type of work and length of service since graduation
9 months Private duty - It mary Hasp Rochester mine
9 months - staff mirse. Henry El. Settlement new particity
2 1/2 months School muse manmouth Co. Qug for Social service
Red Bank new firsey.
(Present position)
not employed.
shome 901 Henry St. neenshi Wis
19. Will you be willing to accept active service if the United States becomes involved in war?
yes
20.
(a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing Instructor,
Home Hygiene and Care of Sick, Army, Navy, U. S. Public Health Service, U. S. Veterans' Bureau.
(b) Date upon which you will be available
Jest 1, 1926
21. Are you willing to take the oath of allegiance?
22.
Name and permanent address of near relative (give relationship) Andersen
yes
2
901 Henry street neenah, Huscomin
Date
NOTE Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill
January 1926 Signature of nurse Sena Andersen
out questions 23 and 24 on reverse side of this blank.
To The Local Committee:
This blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.
ok.
703. Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193
should be forwarded to National Headquarters or to the proper Branch Office.
HEVT LH
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"ocrText": "D\nS\na\ner\n1\nS\nForm 1037\nRev. 3-1-25\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1.\nName of applicant in full Sena Andersen\n2. Address in\nfull f 901 Henry Street, neenah, Wisconsin\n3) 3. Date Birthplace of birth of father may Denmark 24, 1895 Mother Race Denmark White Place of birth Citizenship neenah, of father Wisconsin U.S.\n4. Are you married, single or a widow? Single Are you a citizen of the United States? yes\n5. How many years have you attended grammar school? 8 High school? 4 Normal school? 2\nPrivate school?\nCollege? It If tutored privately, name subjects covered and length of time\n6. you\nWhat languages other than English do speak? Danish German\n(Underline those which you speak fluently.)\n7.\nOccupation before entering training school Teaching Public Schools\n8.\nFrom what hospital training school did you receive your diploma? St. mary Hospital\nCity and State Rochester minnesstapste of graduation\nSena Andersen\nJune 1922\nGive name at time of graduation\n9. Character of hospital: General? general Special?\nPrivate?\n10. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? yes\n11.1 Daily average number of patients in hospital during training 600\nLength\nof\ncourse\n3\nyears\n12. Name and address of superintendent of nurses under whom you received training\nSister Diomying, St. marip Hospital- Rochester. minnesota.\n13.\nIf your training as a nurse was received in more than one hospital, give name, location and time spent in each\nCity County Hosp., St.Paul. minn. 8 months,\n14. Of what nursing organizations are you a member? not nurses organization\nalumni St. marip Hosp-Rochector, min. not Qug for Public Health Mus.\n15. Which, if any, is affiliated with the American Nurses' Association?\n16. Give name and address of secretary of at least one of these organizations mins anna Fetterson\n370-7th.am. new York city\nnewyork.\noct.1925 number - 24751\n17. Are you a registered nurse? yes in what State? minnesis Date of registration here 1922 Number - 4574\n18. Type of work and length of service since graduation\n9 months Private duty - It mary Hasp Rochester mine\n9 months - staff mirse. Henry El. Settlement new particity\n2 1/2 months School muse manmouth Co. Qug for Social service\nRed Bank new firsey.\n(Present position)\nnot employed.\nshome 901 Henry St. neenshi Wis\n19. Will you be willing to accept active service if the United States becomes involved in war?\nyes\n20.\n(a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing Instructor,\nHome Hygiene and Care of Sick, Army, Navy, U. S. Public Health Service, U. S. Veterans' Bureau.\n(b) Date upon which you will be available\nJest 1, 1926\n21. Are you willing to take the oath of allegiance?\n22.\nName and permanent address of near relative (give relationship) Andersen\nyes\n2\n901 Henry street neenah, Huscomin\nDate\nNOTE Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill\nJanuary 1926 Signature of nurse Sena Andersen\nout questions 23 and 24 on reverse side of this blank.\nTo The Local Committee:\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.\nok.\n703. Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193\nshould be forwarded to National Headquarters or to the proper Branch Office.\nHEVT LH"
}