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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-24-36.
D
Application for Enrollment
a
(To be filled out entirely in applicant's handwriting and each question answered fully.)
a
1. Name of applicant in full administer anna Royd
If married, give maiden name
Permanent address in full. a tkins ankamars
J/
*2.
Probable
address for one year Box 234 Shigher Oklahoma
D
n
Date of birth
Dec. 2 1903 Race white Place of birth atkins, ask
3.
Birthplace of father (Month) So eardin (Day) Mother miss. Citizenship of father U S.a.
(Year)
5
5
Are you a citizen of the United States?
yes
4.
Are you single, married, a widow, or divorced? Single
a
5. How many years have you attended Grammar School? 8 High school? 3. Normal school?
Private school?
College? 3. If tutored privately, name subjects covered and length
of
time Business collage, 6. mos
6. What languages other than English do you speak? name
(Underline those which you speak fluently)
7. Occupation before entering school of nursing Stenographer
8.
From what school of nursing did you receive your diploma? m morgan ren Hock
City and State muskagee okla Date of graduation may 1935
9. Character of Hospital: General?
Special?
Private?
10. Did your training include medical and surgical care of men? agen Of women? yes
Pediatrics? yes Obstetrics? are Communicable diseases? -
11. Daily average number of patients in hospital during training 3524 Length of course 3 yrs
12. Name and address of director of school of nursing under whom you received training miss
Edma In Rocksfeller, 518 Baltimore St. muckagee, okla.
13. If your education as a nurse was received in more than one hospital, give name, location and
14. 2time Are you a member of your Alumnae Association? ajas -
spent in each initiality Hosp, ela cland O - telmas Amos, (psychuatry)
15. Are you affiliated with the American Nurses' Association through membership in District and
State Associations? ayer
Affiliation with the American Nurses' Association means active membership in a District and Graduate Nurses' Association
16. Give name and address of secretary of the District or State Association of which you are a
member miss C. matthews, Sanny 6131 Friend It elinton, okla.
17. Are you a registered nurse?.ayea In what State okl Date of registration 12/10/3 Number 7986
18. Type of work and length of service since graduation:
night period Jind l Hosk. Elk city Okls -3mos.
Private duty. - 6 mos
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
Check to indicate whether you would prefer assignment with the Army Nurse Corps
or Navy Nurse Corps
20. Are you willing to take the oath of allegiance? uses
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
mms (state Blanche Boyd (mother) atkim and
relationship).
Date 9/12/38
Signature of Nurse
ada anna Boyd
*Addresses must be given in full, including street, city and state.
(OVER)
Page data
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- Type
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Document data
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- Core
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- Type
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"ocrText": "THE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-24-36.\nD\nApplication for Enrollment\na\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\na\n1. Name of applicant in full administer anna Royd\nIf married, give maiden name\nPermanent address in full. a tkins ankamars\nJ/\n*2.\nProbable\naddress for one year Box 234 Shigher Oklahoma\nD\nn\nDate of birth\nDec. 2 1903 Race white Place of birth atkins, ask\n3.\nBirthplace of father (Month) So eardin (Day) Mother miss. Citizenship of father U S.a.\n(Year)\n5\n5\nAre you a citizen of the United States?\nyes\n4.\nAre you single, married, a widow, or divorced? Single\na\n5. How many years have you attended Grammar School? 8 High school? 3. Normal school?\nPrivate school?\nCollege? 3. If tutored privately, name subjects covered and length\nof\ntime Business collage, 6. mos\n6. What languages other than English do you speak? name\n(Underline those which you speak fluently)\n7. Occupation before entering school of nursing Stenographer\n8.\nFrom what school of nursing did you receive your diploma? m morgan ren Hock\nCity and State muskagee okla Date of graduation may 1935\n9. Character of Hospital: General?\nSpecial?\nPrivate?\n10. Did your training include medical and surgical care of men? agen Of women? yes\nPediatrics? yes Obstetrics? are Communicable diseases? -\n11. Daily average number of patients in hospital during training 3524 Length of course 3 yrs\n12. Name and address of director of school of nursing under whom you received training miss\nEdma In Rocksfeller, 518 Baltimore St. muckagee, okla.\n13. If your education as a nurse was received in more than one hospital, give name, location and\n14. 2time Are you a member of your Alumnae Association? ajas -\nspent in each initiality Hosp, ela cland O - telmas Amos, (psychuatry)\n15. Are you affiliated with the American Nurses' Association through membership in District and\nState Associations? ayer\nAffiliation with the American Nurses' Association means active membership in a District and Graduate Nurses' Association\n16. Give name and address of secretary of the District or State Association of which you are a\nmember miss C. matthews, Sanny 6131 Friend It elinton, okla.\n17. Are you a registered nurse?.ayea In what State okl Date of registration 12/10/3 Number 7986\n18. Type of work and length of service since graduation:\nnight period Jind l Hosk. Elk city Okls -3mos.\nPrivate duty. - 6 mos\n19. Are you willing to accept service if the United States becomes involved in war?\nyes\nOr, service with the American Red Cross in time of disaster or great emergency? yes\nCheck to indicate whether you would prefer assignment with the Army Nurse Corps\nor Navy Nurse Corps\n20. Are you willing to take the oath of allegiance? uses\n21.\nAre 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\nmms (state Blanche Boyd (mother) atkim and\nrelationship).\nDate 9/12/38\nSignature of Nurse\nada anna Boyd\n*Addresses must be given in full, including street, city and state.\n(OVER)"
}