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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
any
D
11
ce
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
MRS. ROSE A. KNAUSS,
Chairman or
Nurses should report at once to the
422 EAST CEDAR S1.
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
POUGHKEEPSIE, N. Y. Local Committee.
the address of the Secretary.
Name
in (Miss) full alice L.Buckland.
If married, give husband's name no
Permanent address (STREET) ETC.) Banatorum, (CITY) (COUNTY) Centry
municipal
Probable address for the next year asabove.
(STATE) newlight
Dialhs Distance
(STREET. ETC.)
Telephone No. -Call3nFF-39F1).
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Father m. George a. Buckland- 7917 Payten ave. Chicago,
Underline the type of work you are now doing:
Delivies
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health, - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Outdoor I uty- mmatori-
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? NO.
Have assistantinFirstidclasses. you eyer been? Only, Would you like to teach Red Cross classes? YES. notpermit. Time doss
Indicate present physical condition Very good.
Would coued you beilived. respond to an emergency call in event of epidemic, disaster, war, etc.? yes. its
Badge No. 2596
Current date march 6- k 39.
communication of Dec 9-38 recid from Director washDe re; change
NOTE. -- If the nurse does not complete and return this questionnaire, and can not be
ment
record
of enroll-
u
located within two years, her enrolment will be removed from our active files.
Pound Rkeeksie,n.Y.
oar dito
5
I
6

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ID: 2661175
Core: doc
Type: document

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Document source extras

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        "logicalDate": "1946-02-12",
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Page context

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    "ocrText": "a\nc\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nany\nD\n11\nce\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nMRS. ROSE A. KNAUSS,\nChairman or\nNurses should report at once to the\n422 EAST CEDAR S1.\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nPOUGHKEEPSIE, N. Y. Local Committee.\nthe address of the Secretary.\nName\nin (Miss) full alice L.Buckland.\nIf married, give husband's name no\nPermanent address (STREET) ETC.) Banatorum, (CITY) (COUNTY) Centry\nmunicipal\nProbable address for the next year asabove.\n(STATE) newlight\nDialhs Distance\n(STREET. ETC.)\nTelephone No. -Call3nFF-39F1).\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nFather m. George a. Buckland- 7917 Payten ave. Chicago,\nUnderline the type of work you are now doing:\nDelivies\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health, - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nOutdoor I uty- mmatori-\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? NO.\nHave assistantinFirstidclasses. you eyer been? Only, Would you like to teach Red Cross classes? YES. notpermit. Time doss\nIndicate present physical condition Very good.\nWould coued you beilived. respond to an emergency call in event of epidemic, disaster, war, etc.? yes. its\nBadge No. 2596\nCurrent date march 6- k 39.\ncommunication of Dec 9-38 recid from Director washDe re; change\nNOTE. -- If the nurse does not complete and return this questionnaire, and can not be\nment\nrecord\nof enroll-\nu\nlocated within two years, her enrolment will be removed from our active files.\nPound Rkeeksie,n.Y.\noar dito\n5\nI\n6"
}

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