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D a < Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE M Name in full Davis Mary Thornton Tel. No. home 4829 Mass office 6969 Greening a (last) (first) (middle) If married, give maiden name - Year of birth 1890 Marital status single - Husband's name (single, martied, widowed, divorced) Permanent address (22 her St. maiblebead ussex mass mothers address ) (street) (county) (state) we Green (city) Probable address firedrunders for the next year 8 H figh (street) SV greenpeld (city) Frauklin (county) mass (state) morified office 14, tope SV. Give name and address of nearest relative or friend in United States: Mrs. Francis de Lancey Cunninsham (relationship) (Sister) 64So (address) mountain Rd Pittsfied mans. (name) Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health quantied Visiting nurse Association - 14 Hope Sv.tl.6969 Industrial Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration 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 Private schools. - equin to lys. Collige 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-hoopital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Public health nursing 8mos. Teacheis College, Columbiats. n.4. Anaesthesia 25 years a 2. Have you taken any courses in a college or university? Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in *one year year years years years degree degree degree Public Health 2 days / 6 In what major was field above study? Public Health nursing 0 What languages, other than English, do you speak? none fluantty. no practice since 1920 RJ was able to make my self understood is French & to Extent in anthover) ettalian 8 * Academic year Studied trucht german in School about 10 grant could get long aither about 1910.

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