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B I / RED CROSS BADGE NUMBER AMERICAN RED CROSS 20078 NURSING SERVICES MILITARY SERIAL NUMBER M ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED 1 NAME (Last, first, middle) TELEPHONE NO. S. Estelle Weltman Blatt Bit 7000 IF MARRIED, GIVE MAIDEN NAME HUSBAND'S NAME Max Blatt Noltman E PERMANENT ADDRESS (Street, city, zone, county, state) 501 Surf Street Chicago (14) Illinois 10 PRESENT ADDRESS (Street, city, zone, county, state) + 501 Surf Street Chicago NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP a Max Blatt, 501 Surf Street - 134 N. La Salle Street Husband // = DATE OF BIRTH (Month, day, year) Single Married Separated Widowed Divorced Aug 7, 1890 x YES NO e e WHAT LANGUAGES DO YOU SPEAK? HIGH SCHOOL GRADUATE German- little French x NAME OF COLLEGE OR DePaul- and summers at different U's DEGREE OR B.S. Science It, UNIVERSITY ATTENDED Northwestern LOCATION Chicago INCLUSIVE DATES DIPLOMA M.Ed. MAJOR Educatio tman R ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? x Illinois NURSES' ASSOCIATION? x PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) Director, Home Nursing Service, Chicago Chapter NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE Chicago Chapter, A.R.C. Chic ago, Illinois HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY good VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able to serve if called on within the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS YES Attend an instructors' training program, 1f offered. (Funds are available for YES NO 1. Teach home NO nursing classes X training home nursing instructors. See local chapter.) 2. Serve in case YES NO only in home community Attend disaster institutes, if YES NO of disaster In other communitie offered, in preparation for service NO 5. Assist with other chapter YES NO 3. Teach nurse's YES NO 4. Accept membership on chapter com- YES aide classes mittee should services be needed programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE MAJOR REASONS DATE IGNATUBE August 20, 1945 Callelle Wetman Blatt Ty YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN 2 KEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETIRN to PROMPTLY TO THE MISS COMMITTEE NAMED BELOW. DULIA A. MacNEILL, R.N. ATTENTION Fill in committee name and address before sending questionna ire to SECRETARY COMMITTEE apaira 5.29 so. WABASH AVE. NURSE RECRUITMENT CHICAGO 5, ILLINOIS 8 78504M FORM 1045 Rev. July 1945

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    "ocrText": "B\nI\n/\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n20078\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nM\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\n1\nNAME (Last, first, middle)\nTELEPHONE NO.\nS.\nEstelle Weltman Blatt\nBit 7000\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nMax Blatt\nNoltman\nE\nPERMANENT ADDRESS (Street, city, zone, county, state)\n501 Surf Street Chicago (14) Illinois\n10\nPRESENT ADDRESS (Street, city, zone, county, state)\n+\n501 Surf Street Chicago\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\na\nMax Blatt, 501 Surf Street - 134 N. La Salle Street\nHusband\n//\n=\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nAug 7, 1890\nx\nYES\nNO\ne\ne\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\nGerman- little French\nx\nNAME OF COLLEGE OR\nDePaul- and summers at different U's\nDEGREE OR B.S.\nScience\nIt,\nUNIVERSITY ATTENDED Northwestern LOCATION Chicago\nINCLUSIVE DATES\nDIPLOMA\nM.Ed. MAJOR Educatio\ntman\nR\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nx\nIllinois\nNURSES' ASSOCIATION?\nx\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nDirector, Home Nursing Service, Chicago Chapter\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nChicago Chapter, A.R.C.\nChic ago, Illinois\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nYES\nAttend an instructors' training program, 1f offered. (Funds are available for\nYES\nNO\n1. Teach home\nNO\nnursing classes\nX\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communitie\noffered, in preparation for service\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS\nDATE\nIGNATUBE\nAugust 20, 1945\nCallelle Wetman Blatt Ty\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS\nIN\n2\nKEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETIRN to PROMPTLY TO THE\nMISS\nCOMMITTEE NAMED BELOW.\nDULIA A. MacNEILL, R.N.\nATTENTION\nFill in committee name and address before sending questionna ire to\nSECRETARY\nCOMMITTEE\napaira\n5.29 so. WABASH AVE.\nNURSE RECRUITMENT\nCHICAGO 5, ILLINOIS\n8\n78504M\nFORM 1045 Rev. July 1945"
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