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PORAS
Form 1037
Rev. May,1939
THE AMERICAN RED CROSS NURSING SERVICE
APPLICATION FOR ENROLLMENT
M
(To be filled out in applicant's handwriting and each question answered fully)
1. Name of applicant in full
mary marget Dodde Date of birth February (Month) (Day) 15th (Year) 1916
If married, give maiden name
2. Permanent address
Hillsdale
(Gity)
New (State) York
is
Probable address for year (Street) 419 (Street) West 114thst neet (City) new your City (State) New you
one
3.
Race white Place of birth Hillsdale newyork Marital status (single, single married widowed
or divorced)
Birthplace of father Ireland
Mother Ireland Citizenship of father U.S.
T
Are you a citizen of the United States? yes/
9
4. GENERAL EDUCATION (prior to entéring nursing) :
No. of years
Did you graduate?
e
attendance
Yes or No
High School
4 years
yes
+
Normal school
1. year
no
College or University
Other
What languages other than English do you speak?
(Underline those which you speak fluently)
5. PROFESSIONAL EDUCATION:
a. School of Nursing from which you graduated :
st Lukes (Name) Hospital
newYork (City) City
new (State) York
Date of graduation September 15th 939
Length of course
3 years
Daily Average
Character of hospital : General or special
No. of patients
364
during training
In this hospital, which services did you receive experience in as segregated services (underline) :
Eye, Ear Communicable
Outpatient
Medicine- - Surgery - Pediatrics - Obstetrics- - Nose & 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 - Department
b. Undergraduate affiliations :
Clinical
Hospital or Organization
City and State
specialty
No. months
(1) Deurological Institute
neurology
new york 11 City
perchasing
3months
(2) Slvane Hospital for Women
abstetines 3months
(3) Williard Parker Hospital
Communicable decians 3 months
"
c. Postgraduate clinical or field courses (Do not include academic work).
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
8
(3)
d. Academic study since graduation from Nursing School.
5
College or University
City and State
Nature of work
No. months
(1)
W
(2)
VAD
W
(3)
(OVER)
2
Page data
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- 115
- Source index
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- Type
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- Media ID
- 21491dedf8d938d7
- Size
- unknown
Document data
- ID
- 2661371
- Core
- doc
- Type
- document
DTO data
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"ocrText": "PORAS\nForm 1037\nRev. May,1939\nTHE AMERICAN RED CROSS NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\nM\n(To be filled out in applicant's handwriting and each question answered fully)\n1. Name of applicant in full\nmary marget Dodde Date of birth February (Month) (Day) 15th (Year) 1916\nIf married, give maiden name\n2. Permanent address\nHillsdale\n(Gity)\nNew (State) York\nis\nProbable address for year (Street) 419 (Street) West 114thst neet (City) new your City (State) New you\none\n3.\nRace white Place of birth Hillsdale newyork Marital status (single, single married widowed\nor divorced)\nBirthplace of father Ireland\nMother Ireland Citizenship of father U.S.\nT\nAre you a citizen of the United States? yes/\n9\n4. GENERAL EDUCATION (prior to entéring nursing) :\nNo. of years\nDid you graduate?\ne\nattendance\nYes or No\nHigh School\n4 years\nyes\n+\nNormal school\n1. year\nno\nCollege or University\nOther\nWhat languages other than English do you speak?\n(Underline those which you speak fluently)\n5. PROFESSIONAL EDUCATION:\na. School of Nursing from which you graduated :\nst Lukes (Name) Hospital\nnewYork (City) City\nnew (State) York\nDate of graduation September 15th 939\nLength of course\n3 years\nDaily Average\nCharacter of hospital : General or special\nNo. of patients\n364\nduring training\nIn this hospital, which services did you receive experience in as segregated services (underline) :\nEye, Ear Communicable\nOutpatient\nMedicine- - Surgery - Pediatrics - Obstetrics- - Nose & Throat- - Diseases - Psychiatry - Department\nIn this hospital, which services did you receive experience in as non-segregated services (underline)\n:\nEye, Ear\nCommunicable\nOutpatient\nMedicine-Surgery-Pediatrics-Obstetrics-Nose - & Throat- -- Diseases - Psychiatry - Department\nb. Undergraduate affiliations :\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1) Deurological Institute\nneurology\nnew york 11 City\nperchasing\n3months\n(2) Slvane Hospital for Women\nabstetines 3months\n(3) Williard Parker Hospital\nCommunicable decians 3 months\n\"\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)\n8\n(3)\nd. Academic study since graduation from Nursing School.\n5\nCollege or University\nCity and State\nNature of work\nNo. months\n(1)\nW\n(2)\nVAD\nW\n(3)\n(OVER)\n2"
}