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an
January'
Form 1037
Rev. May, 1939
THE AMERICAN RED CROSS NURSING SERVICE
APPLICATION FOR ENROLLMENT
I
(To be filled out in applicant's handwriting and each question answered fully)
5
23
1. Name of applicant in full Physics Lou Earne
Date of birth irrigan (Month) (Day) 23 1917 (Year)
M
If married, give maiden name
, lliis
2. Permanent address 37 mansfield St. Everett
mass
(Street)
(City)
(State)
Probable address for one year 37 manefield st., Everett
(Street)
(City)
mass
(State)
3. Race White Place of birth, Boston mass. Marital status (single, single married, widowed
or divorced)
Birthplace of father albany n. 4 Mother Canada Citizenship of father american
Are you a citizen of the United States? yes
4. GENERAL EDUCATION (prior to entering nursing) :
No. of years
Did you graduate?
attendance
Yes or No
High School
4 years
yes
Normal school
College or University
Other 75
What languages other than English do you speak?
none
(Underline those which you speak fluently)
5. PROFESSIONAL EDUCATION:
a. School of Nursing from which you graduated:
Whidden memorial Hospital
Everett
massachusetts
(Name)
(City)
(State)
Date of graduation november 2 1939
Length of
course
3 years
Character of hospital General or special General
Daily Average
No. of patients
94+
during training
In this hospital, which services did you receive experience in as segregated services (underline) :
accident
Eye, Ear Communicable
Outpatient and
Medicine - Surgery Pediatrics - Obstetrics- Nose & Throat - Diseases - Psychiatry - Departmentx ran
In this hospital, which services did you receive experience in as non-segregated services (underline) :
dept.
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) Boston City Hospital Boston, make Pediatrics Communicable
3 mo
(2) Haynes Hem Hospital Brighton
mass.
describer
3 mo
(3)
c. Postgraduate clinical or field courses (Do not include academic work).
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
8
(2)
(3)
d. Academic study since graduation from Nursing School.
College or University
City and State
Nature of work
No. months
(1)
(2)
(3)
(OVER)
Page data
- Page
- 91
- Source index
- 0
- Type
- photo
- Media ID
- 89de2187d08ce2bd
- Size
- unknown
Document data
- ID
- 2661441
- Core
- doc
- Type
- document
DTO data
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"ocrText": "-\nan\nJanuary'\nForm 1037\nRev. May, 1939\nTHE AMERICAN RED CROSS NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\nI\n(To be filled out in applicant's handwriting and each question answered fully)\n5\n23\n1. Name of applicant in full Physics Lou Earne\nDate of birth irrigan (Month) (Day) 23 1917 (Year)\nM\nIf married, give maiden name\n, lliis\n2. Permanent address 37 mansfield St. Everett\nmass\n(Street)\n(City)\n(State)\nProbable address for one year 37 manefield st., Everett\n(Street)\n(City)\nmass\n(State)\n3. Race White Place of birth, Boston mass. Marital status (single, single married, widowed\nor divorced)\nBirthplace of father albany n. 4 Mother Canada Citizenship of father american\nAre you a citizen of the United States? yes\n4. GENERAL EDUCATION (prior to entering nursing) :\nNo. of years\nDid you graduate?\nattendance\nYes or No\nHigh School\n4 years\nyes\nNormal school\nCollege or University\nOther 75\nWhat languages other than English do you speak?\nnone\n(Underline those which you speak fluently)\n5. PROFESSIONAL EDUCATION:\na. School of Nursing from which you graduated:\nWhidden memorial Hospital\nEverett\nmassachusetts\n(Name)\n(City)\n(State)\nDate of graduation november 2 1939\nLength of\ncourse\n3 years\nCharacter of hospital General or special General\nDaily Average\nNo. of patients\n94+\nduring training\nIn this hospital, which services did you receive experience in as segregated services (underline) :\naccident\nEye, Ear Communicable\nOutpatient and\nMedicine - Surgery Pediatrics - Obstetrics- Nose & Throat - Diseases - Psychiatry - Departmentx ran\nIn this hospital, which services did you receive experience in as non-segregated services (underline) :\ndept.\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) Boston City Hospital Boston, make Pediatrics Communicable\n3 mo\n(2) Haynes Hem Hospital Brighton\nmass.\ndescriber\n3 mo\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)\n8\n(2)\n(3)\nd. Academic study since graduation from Nursing School.\nCollege or University\nCity and State\nNature of work\nNo. months\n(1)\n(2)\n(3)\n(OVER)"
}