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    "title": "Ford, Netta",
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    "coverageEndDate": {
        "day": 14,
        "logicalDate": "1945-08-14",
        "month": 8,
        "year": 1945
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        "year": 1917
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    "ocrText": "F\n0\nT\n4 Boss\na\nN\nNURSING SERVICE\ne\n+\n+\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting and each question answered fully)\ne\n1. Name of applicant in full netta Ford\n2. Address in full, Street 800 € market Street.City\nyork\nState\nPas\n3. Date of birth\naugust 31 19.9.0.\nPlace of birth\nariel Pa\n4. Are you married, or a\nsingle widow? Single\nAre you a citizen of the United States? yrs\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no\nAre you physically strong and healthy? yes\n6. Name educational institutions attended before entering training school, stating number of years at each and from which\nyou\nwere graduated\nPublic\nschools of Penna graduated Steelter\nHigh Schne Steelton Par\n7. What languages other than English do you speak?\nnone\n8. Occupation before entering training school\n9.\nFrom what hospital training school did you receive your diplo ma? St Lin this Hospital Francing Schnol.\nSchool teaching\nCity and state Roxbourgugh Philadelphin Pa\nDate of graduation\nmay 20th 1915\n10. Character of hospital: General? yes\nSpecial?\nPrivate?\n11. Did your training include obstetrics? yrs Care of men? yrs Children? yrs Contagious diseases? yrs.\n12. Daily average number of patients in hospitals during training 80 patien to Length of B. yrs\ncourse\n13. Name and address of superintendent of training school under whom you received training miss Eva Simonton\nSt, Smothing Hospital Rox briough Philadelphia Pa Philadelphia\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nHospital for contagion Diseases 5\nworks\n15. Of what nursing organizations are you a member? St Smithy alumne association\nnational organization for Public stealth having\n16. Which, if any, is affiliated with the American Nurses Association?. st Smothy alumne asser n.o.P.A.M.\n17. Give name and address of secretary of at least one of these organizations miss many Septem 4301 manayank\nan Boxbnough Philadelphia G Raine an\n18. Are you a registered nurse? yes\nIn what state?\nPar\nDate of registration June 16 1915\n19. State how, where and for what period of time, in each instance, you have been employed since graduation, including present\nemployment, giving name and address of persons in charge\n4 months Printe nursing\n16 months Visiting murr assimiation Erie, Pa L. d5. man tumes\nSupt murses 42. 3. &. la el Street Erie, Pa Supt 2 initing numer\nassociation york Pa 7mrs miss anna h. L stular President\nVisiting numar assressntin 3.3.3 East market Street york Pa\n(Specify for which of the following services you wish to be considered.)\n20.\nWar service, wherever needed U.\nS. only\nWhen available\nAre you willing to take the oath of allegiance? wro\n21. Instructor, Elementary Hygiene yrs York, Pa Home Dietetics\nSurgical Dressings yes ynh Pa\n22. Public Health Nursing in Town and Country Nursing Service.\n23. Name and permanent address of nearest relative mrs Clara E Ford 514 Rim st\nHawley Pa Wayne Co\nDate Sept 41917\nSignature\nnetter Ford\nTo the Committee:\nThis blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, and A. R. C. 150.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorsement\nby Local Committee, with credentials (Forms 3 and 4) together with Forms 10 and 11, should be forwarded to the Chairman,\nNational Committee on Nursing Service, American Red Cross, Washington, D. C.\nIn case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local\nCommittee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-\nmittee, from whence credentials will be procured.\nREQ. 17-876-May 20M"
}