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a a + J FORM 1037 AMERICAN RED CROSS NURSING SERVICE REV. FEB. 1941 APPLICATION FOR ENROLLMENT (To be filled out in applicant's handwriting and each question answered fully) 1. Name of applicant in full June Mayjanne Dec Shane If married, give maiden name 2. Permanent address 308 Hungerford avenue, neganes, (Street) (City) marquette (County) michigan (State) 3. Probable address for one year. 308 Hengerford Ave neganne marquette Michigan (Street) (City) (County) (State) 4. Name and permanent address of nearest relative or friend residing in the United States: F Mr. Mrs. Frank (Name) Dushane, 308 Hungerford Address) Ave, negarme mich Parents (Relationship) 5. Race 6. Present Marital Status 7. Citizenship 8. What languages other than English do you speak? White Single Native born None German Negro Married Naturalized Spanish Scandinavian Other Widowed Non citizen French Polish Divorced Italian Other Catholic Sister pinnish 9. Date of birth august 31, 19.00 Place of birth takpening, Michigants Father a citizen of the Yes United States? No 10. General education (prior to entering nursing): Did you graduate from high school Yes If no, how many years of high school do you lack? No a What college or university education did you have prior to entering nursing? X. None or less S 1 year; 2 years; 3 years; Bachelors Masters PH.D. than 1 year; Degree; Degree; 11. Nursing Education: a. School of nursing from which 5 graduated St.Lukes Hospital School (Name) of nursing marquette &City) Michigan (State) Date of graduation June 30 19.42 Length of course: 5 years; x 3 years; (Specify Other) b. Undergraduate affiliations: Clinical Hospital or Organization City and State specialty No. months (1) University Hospital ann arbor, Michigan Surgery 3 (2) gynchology (3) c. Postgraduate clinical courses (Do not include academic work or employment) Clinical Hospital or Organization City and State specialty No. months (1) (2) (3) d. Academic study since graduation from School of Nursing: College or University City and State Number of full time Number of academic years points (1) (2) (3) e. Check all degrees obtained Bachelors 5 Masters PH. D. Certificate in Public Health subsequent to entering training: Degree; Degree; Nursing f. In which major field was your academic study? Institutional Public Health s Non nursing (specify) Other (specify) (Over) 18

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    "ocrText": "a\na\n+\nJ\nFORM 1037\nAMERICAN RED CROSS NURSING SERVICE\nREV. FEB. 1941\nAPPLICATION FOR ENROLLMENT\n(To be filled out in applicant's handwriting and each question answered fully)\n1. Name of applicant in full\nJune Mayjanne Dec Shane\nIf married, give maiden name\n2. Permanent address 308 Hungerford avenue, neganes,\n(Street)\n(City)\nmarquette (County) michigan (State)\n3. Probable address for one year. 308 Hengerford Ave\nneganne\nmarquette\nMichigan\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nF\nMr. Mrs. Frank (Name) Dushane, 308 Hungerford Address) Ave, negarme mich Parents\n(Relationship)\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nspeak?\nWhite\nSingle\nNative born\nNone\nGerman\nNegro\nMarried\nNaturalized\nSpanish\nScandinavian\nOther\nWidowed\nNon citizen\nFrench\nPolish\nDivorced\nItalian\nOther\nCatholic Sister\npinnish\n9. Date of birth august 31, 19.00 Place of birth takpening, Michigants Father a citizen of the\nYes\nUnited States?\nNo\n10. General education (prior to entering nursing):\nDid you graduate from high school\nYes\nIf no, how many years of high school do you lack?\nNo\na\nWhat college or university education did you have prior to entering nursing?\nX. None or less\nS\n1 year;\n2 years;\n3 years;\nBachelors\nMasters\nPH.D.\nthan 1 year;\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\n5\ngraduated St.Lukes Hospital School (Name) of nursing marquette &City)\nMichigan\n(State)\nDate of graduation June 30\n19.42\nLength of course:\n5 years; x 3 years;\n(Specify Other)\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1) University Hospital\nann arbor, Michigan\nSurgery\n3\n(2)\ngynchology\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nd. Academic study since graduation from School of Nursing:\nCollege or University\nCity and State\nNumber of full time\nNumber of\nacademic years\npoints\n(1)\n(2)\n(3)\ne. Check all degrees obtained\nBachelors\n5 Masters\nPH. D.\nCertificate in Public Health\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\nInstitutional\nPublic Health\ns Non nursing (specify)\nOther (specify)\n(Over)\n18"
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