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- Parte de Records of the American National Red Cross, Historical Nurse Files
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OCR Page 1 of 85Form 1037
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Rev. 10-20-30
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1.
Name of applicant in full Bunge, Helen -athrop
2. Permanent address in full 417 South Fourteenth St. paprosse, wis.
Probable address for one year bescourin general Hospital madison, linev
is
3. Date of birth Oct " 1906 Race Geurican Place of birth Lalrosse wis
(Month)
(Day)
(Year)
Birthplace of father munnesata Mother bescousin Citizenship of father amen ear
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 summer schools
Private school ?
College? 4 If tutored privately, name subjects covered and length
a
of time
+
6. What languages other than English do you speak?
5
(Underline those which you speak fluently)
7.
Occupation before entering training school student
C
8. From what hospital training school did you receive your diploma? ugglus Schuoly hursing
City and State medison wisconson Date of graduation nou. 2, 1930
9. Character of Hospital General? yes
Special
Private?
10. Did your training include medical and surgical care of men? yes Of women? yes
Pediatrics? yes
Obstetrics? yes
Communicable diseases? yes
11. Daily average number of patients in hospital during training 450 Length of course 5yr.
12. Name and address of superintendent of nurses under whom you received training
This Helen I Denne his general Hospital, madison, leies
13. If your training as a nurse was received in more than one hospital, give name, location and time
spent in each
14. Are you a member of your Alumnae Association? yes
15. Are you affiliated with the American Nurses' Association through membership in Alumnae, Dis-
trict and State Associations? yes
Affiliation with the American Nurses' Association means 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
mishena *. Schmidt 22 h Hancock; madison his
17. Are you a registered nurseifes In what State?klis.Date of registration/ay6-193/ Number $324
18. Type of work and length of service since graduation:
Instructor since Jar1,1931 -
(Present position)
19. Will you be willing to accept serVice if the United States becomes involved in war? yes
Instructor in 6 glues School of nursing
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 for service checked
21. Are you willing to take the oath of allegiance? yes
22. Give name and permanent address of nearest relative or friend, residing in the United States
(state relationship).
hr. george 3 Bunge; 117 South fourteeth St; ha Crosse, huscouse
Date 10-173,
Signature of nurse.
Helen L Buege
5
NOTE-Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill 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. 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.
(OVER)
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