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5
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Form 1037
Rev. Jan., 1941
AMERICAN RED CROSS
APPLICATION FOR ENROLLMENT
(To be filled out in applicant's bandwriting and each question answered fully)
a
1. Name of applicant in full Diehl, Elizabeth Arabella Date of birth July (Month) 5 1911
b
(Day) (Year)
2.
Permanent address 1612 Pine St Phila Phila Penna
If married, give maiden name
Probable address for year (Street) 1612 Pine St (City) Phila (County) Phila
(State)
one
Perma
5
(Street)
(City)
(Couuty)
3. Race White
Marital status
Single
(State)
Place of birth Fenna
Birthplace of father Penna
Mother Penna Citizenship (single, of father married, Emerican (vidowed or divorced)
D
Are you a citizen of the United States? yes
7
4. GENERAL EDUCATION (prior to entering nursing)
No. of years
brevae
Did you graduate?
attendance
Yes or No
a
High school
4
Normal school
yes
5
p
College or University
Other
=
-
What languages other than English do you speak?
none
(Underline those which you speak fluently)
a
5. PROFESSIONAL EDUCATION:
a. School of Nursing from which you graduated:
Methodist Hospital (Name) School of huring
Phita
Penna
(City)
(State)
Date of graduation June 1933
Length of course
Character of hospital: General or special General
Daily ayerage
3 years
No. of patients
150
during training
In this hospital, which services did you receive experience in as segregated services: (underline)
Eye, Ear Communicable
Outpatient
& Throat- Diseases -Psychiatry- Department
In this hospital, which services did you receive experience in as non-segregated services: (underline)
Eye, Ear Communicable
Outpatient
Medicine Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases - Psychiatry-Departmen
b. Undergraduate affiliations:
Clinical
Hospital or Organization
City and State
specialty
No. months
(2) (1) Visiting nurse Society Phila Penna
2
(3)
c. Postgraduate clinical or field courses (Do not include academic work.)
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
(3)
d. Academic study since graduation from School of Nursing:
Cur
College or University
City and State
Nature of work
No. months
(1) iniversity Pennsylvania Phila Penna
Public Halls
I
(2)
BBC (3) except 1936-37 Health which time I had of full years work (OYER) from
Fland been attending the University part time since 1935
0
Public certificate
8
U
N
Page data
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- Source index
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- Type
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- Media ID
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Document data
- ID
- 2661363
- Core
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- Type
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DTO data
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"ocrText": "I\n-\ne\n5\nase\nForm 1037\nRev. Jan., 1941\nAMERICAN RED CROSS\nAPPLICATION FOR ENROLLMENT\n(To be filled out in applicant's bandwriting and each question answered fully)\na\n1. Name of applicant in full Diehl, Elizabeth Arabella Date of birth July (Month) 5 1911\nb\n(Day) (Year)\n2.\nPermanent address 1612 Pine St Phila Phila Penna\nIf married, give maiden name\nProbable address for year (Street) 1612 Pine St (City) Phila (County) Phila\n(State)\none\nPerma\n5\n(Street)\n(City)\n(Couuty)\n3. Race White\nMarital status\nSingle\n(State)\nPlace of birth Fenna\nBirthplace of father Penna\nMother Penna Citizenship (single, of father married, Emerican (vidowed or divorced)\nD\nAre you a citizen of the United States? yes\n7\n4. GENERAL EDUCATION (prior to entering nursing)\nNo. of years\nbrevae\nDid you graduate?\nattendance\nYes or No\na\nHigh school\n4\nNormal school\nyes\n5\np\nCollege or University\nOther\n=\n-\nWhat languages other than English do you speak?\nnone\n(Underline those which you speak fluently)\na\n5. PROFESSIONAL EDUCATION:\na. School of Nursing from which you graduated:\nMethodist Hospital (Name) School of huring\nPhita\nPenna\n(City)\n(State)\nDate of graduation June 1933\nLength of course\nCharacter of hospital: General or special General\nDaily ayerage\n3 years\nNo. of patients\n150\nduring training\nIn this hospital, which services did you receive experience in as segregated services: (underline)\nEye, Ear Communicable\nOutpatient\n& Throat- Diseases -Psychiatry- Department\nIn this hospital, which services did you receive experience in as non-segregated services: (underline)\nEye, Ear Communicable\nOutpatient\nMedicine Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases - Psychiatry-Departmen\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(2) (1) Visiting nurse Society Phila Penna\n2\n(3)\nc. Postgraduate clinical or field courses (Do not include academic work.)\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:\nCur\nCollege or University\nCity and State\nNature of work\nNo. months\n(1) iniversity Pennsylvania Phila Penna\nPublic Halls\nI\n(2)\nBBC (3) except 1936-37 Health which time I had of full years work (OYER) from\nFland been attending the University part time since 1935\n0\nPublic certificate\n8\nU\nN"
}