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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-4-33
Application for Enrollment
M
(To be filled out entirely in applicant's handwriting and each question answered fully.)
2. 1. Permanent Name of applicant address in in full full Florence 750 Parnassus Viola are Young In lapt 3, San Francisco, Calif
rs.
Probable address for one year
Same
F
no
3. Date of birth Sept. 25 1906 Race White
Birthplace of (Month) father Iowa (Day) (Year) Mother Iona
Place of birth Pona City, Sorva
-
Citizenship of father american
L
0
Are you a citizen of the United States?
yes
T
4. Are you single, married, a widow, or divorced? Single
(D
5. How many years have you attended Grammar school? 8 High school? 4 Normal school?
5
Private school?
College? 4 If tutored privately, name subjects covered and length
a
C
of time
e
6. What languages other than English do you speak?
more
(Underline those which you speak fluently)
7. Occupation before entering school of nursing school girl
/
8.
From what school of nursing did you receive your diploma?, University of Calif Training school
9. Character of Hospital: General? Special?
City and State San Francisco, state Calil Date of graduation august 16, 1934
Private?
10. Did your training include medical and surgical care of men? yes Of women?
Yes
Pediatrics? Yes Obstetrics? yes Communicable diseases? yest
11. Daily average number of patients in hospital during training 157
Length of course 3 ms.
12. Name and address of superintendent of nurses under whom you received training miss
margarit Tracy 610 Parnassus Ambing saw Francisco, Calif.
13.
If your education as a nurse was received in more than one hospital, give name, location and time
spent in each
Santrainco Visiting Nurseass
2 mo
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 member
17. Are you a registered nurse? yes In what State? Calif Date of registration 7/14/34 Number B-3402
Destrict og Miss Camel young 1155 Pine Street San Trauches Cal.
18. Type of work and length of service since graduation:
Head months nurse ow ward at University of Califor Hospital-fo
7
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?
20. Are you willing to take the oath of allegiance?
yes
yes
21. Are you a qualified public health nurse, or teacher? no
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
(state relationship)
Lawrence Young 1608 Caluena Blvd Hollywood, California.Brother
Date march Signature of Nurse
H Visla young
u
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. 703.
2
Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193 should be
forwarded to National Headquarters.
(OVER)
of
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Document data
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- Type
- document
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"ocrText": "N\nto\nee\ne\na\nto\nFI\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-4-33\nApplication for Enrollment\nM\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n2. 1. Permanent Name of applicant address in in full full Florence 750 Parnassus Viola are Young In lapt 3, San Francisco, Calif\nrs.\nProbable address for one year\nSame\nF\nno\n3. Date of birth Sept. 25 1906 Race White\nBirthplace of (Month) father Iowa (Day) (Year) Mother Iona\nPlace of birth Pona City, Sorva\n-\nCitizenship of father american\nL\n0\nAre you a citizen of the United States?\nyes\nT\n4. Are you single, married, a widow, or divorced? Single\n(D\n5. How many years have you attended Grammar school? 8 High school? 4 Normal school?\n5\nPrivate school?\nCollege? 4 If tutored privately, name subjects covered and length\na\nC\nof time\ne\n6. What languages other than English do you speak?\nmore\n(Underline those which you speak fluently)\n7. Occupation before entering school of nursing school girl\n/\n8.\nFrom what school of nursing did you receive your diploma?, University of Calif Training school\n9. Character of Hospital: General? Special?\nCity and State San Francisco, state Calil Date of graduation august 16, 1934\nPrivate?\n10. Did your training include medical and surgical care of men? yes Of women?\nYes\nPediatrics? Yes Obstetrics? yes Communicable diseases? yest\n11. Daily average number of patients in hospital during training 157\nLength of course 3 ms.\n12. Name and address of superintendent of nurses under whom you received training miss\nmargarit Tracy 610 Parnassus Ambing saw Francisco, Calif.\n13.\nIf your education as a nurse was received in more than one hospital, give name, location and time\nspent in each\nSantrainco Visiting Nurseass\n2 mo\n14. Are 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 with the American Nurses' Association means active membership in the District and Graduate Nurses' Associations of\nthe state in which you are living at the present time.\n16.\nGive name and address of secretary of the District or State Association of which you are a member\n17. Are you a registered nurse? yes In what State? Calif Date of registration 7/14/34 Number B-3402\nDestrict og Miss Camel young 1155 Pine Street San Trauches Cal.\n18. Type of work and length of service since graduation:\nHead months nurse ow ward at University of Califor Hospital-fo\n7\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?\n20. Are you willing to take the oath of allegiance?\nyes\nyes\n21. Are you a qualified public health nurse, or teacher? no\nIf so, please answer the questions on the reverse side of this blank.\n22. Give name and permanent address of nearest relative or friend, residing in the United States\n(state relationship)\nLawrence Young 1608 Caluena Blvd Hollywood, California.Brother\nDate march Signature of Nurse\nH Visla young\nu\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. 703.\n2\nApplication forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193 should be\nforwarded to National Headquarters.\n(OVER)\nof"
}