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Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS JAN 21942 NURSING SERVICE exe Name in full DANIELSON IDA WILMYNA Tel. No. WABASH 4400 (last) (first) (middle) H If married, give maiden name Single Year of birth 1891 a Marital status Single Husband's name -- a (single, married, widowed, divorced) Permanent address -- Walnut Grove Redwood Minnesota (street) (city) (county) (state) Probable address for the next year Stevens Hotel Chicago Cook Illinois / I (street) (city) (county) (state) - Give name and address of nearest relative or friend in United States: Mrs., T. W. Prail Sister WalnutGrove. Minnesota (name) (relationship) (address) in Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed 5 a Institutional Public health Industrial Private duty Other (write in) I Veterans Administration Government Service: Army, Regular Navy, Regular Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital V ox Rublig hoakth (at least 3 months) (at least 6 months) 1 yr PG Communicable disease nursing (include Tbc) study Mayo Psychiatric Nursing Clinic, 1917- 1918 Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? Less than One Three Four Bachelor's Master's P.H.D. Certificate in Two years degree degree Public Health 'one year year years years degree In what major field was above study? -- the What languages, other than English, do you speak? None (Understand considerable German, cannot speak it) (OVER) *Academic year

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    "ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nJAN 21942\nNURSING SERVICE\nexe\nName in full\nDANIELSON\nIDA\nWILMYNA\nTel. No. WABASH 4400\n(last)\n(first)\n(middle)\nH\nIf married, give maiden name\nSingle\nYear of birth\n1891\na\nMarital status\nSingle\nHusband's name\n--\na\n(single, married, widowed, divorced)\nPermanent address\n--\nWalnut Grove\nRedwood\nMinnesota\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nStevens Hotel\nChicago\nCook\nIllinois\n/\nI\n(street)\n(city)\n(county)\n(state)\n-\nGive name and address of nearest relative or friend in United States:\nMrs., T. W. Prail\nSister\nWalnutGrove. Minnesota\n(name)\n(relationship)\n(address)\nin\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\n5\na\nInstitutional\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nI\nVeterans Administration\nGovernment Service: Army, Regular\nNavy, Regular\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nV ox Rublig hoakth\n(at least 3 months)\n(at least 6 months)\n1 yr PG\nCommunicable disease nursing (include Tbc)\nstudy Mayo\nPsychiatric Nursing\nClinic, 1917-\n1918\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\nTwo\nyears\ndegree\ndegree\nPublic Health\n'one year\nyear\nyears\nyears\ndegree\nIn what major field was above study?\n--\nthe\nWhat languages, other than English, do you speak?\nNone\n(Understand considerable German, cannot\nspeak it)\n(OVER)\n*Academic year"
}