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RED CROSS BADGE NUMBER
90882(LootS
IA
AMERICAN RED CROSS
NURSING SERVICES
MILITARY SERIAL NUMBER
+
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
tept
TELEPHONE NO.
NAME (Last, first, middle)
369
Foto STephaNiE FaNNiE
HUSBAND'S NAME
IF MARRIED, GIVE MAIDEN NAME
PERMANENT ADDRESS (Street, city, zone, county, state)
NONE
PRESENT ADDRESS (Street, city, zone, county, state)
/
Wileox memorial Hosp. Lihue. Kauai Hawaii
RELATIONSHIP
NAME Mrs. AND Rose Alexander. 1320 Convention St. Baton Rouge, La.
ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
sister
DATE OF BIRTH (Month, day, year)
Single
Married
Separated
Widowed
Divorced
Dec. 8. 1906.
YES
NO
a
WHAT LANGUAGES DO YOU SPEAK?
English
HIGH SCHOOL GRADUATE
n
DEGREE OR
NAME OF COLLEGE OR
INCLUSIVE DATES
DIPLOMA
MAJOR
LOCATION
n
UNIVERSITY ATTENDED
Louisiana state university
1935-1936
no.
academic
3 semesters
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
alabama
NURSES' ASSOCIATION?
'REGISTERED?
PRESENT EMPLOYMENT If not employed, check
1
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
Anesthetist- O.R. Supervisor.
CITY
STATE
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
Willox memorial Storp. Lihue Kauai T.H.
Lehue Kauai
T.H.
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
good
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are wi liing and able to
serve if called on jithin the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1. Teach home
YES
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
NO
nursing classes
training home nursing instructors. See local chapter.)
only in home community either if
Attend disaster institutes, if
YES
NO
2. Serve in case
YES
NO
In other communities avarable ot leine
offered, in preparation for service
of disaster
NO
5. Assist with other chapter
YES
NO
3. Teach nurse's
4.
Accept membership on chapter cóm-
YES
YES
NO
mittee should services be needed
programs, as needed
aide. classes
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
Note!! UNABLE am returing TO SERVE, GIVE to MAJOR themaeland REASONS - in very nearfulture - hence my hexitankay in felling out This
IF
DATE
SIGNATURE
11-12-45
Stephaine 7. 7oto.
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITRFOLINESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO
this
THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
COMMITTEE
Hamain
PoBex 3948 Handly
FORM 1045 Rev. July 1945
78504M
N
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- Type
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- Size
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Document data
- ID
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- Core
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- Type
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"ocrText": "F\n0\nRED CROSS BADGE NUMBER\n90882(LootS\nIA\nAMERICAN RED CROSS\nNURSING SERVICES\nMILITARY SERIAL NUMBER\n+\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\ntept\nTELEPHONE NO.\nNAME (Last, first, middle)\n369\nFoto STephaNiE FaNNiE\nHUSBAND'S NAME\nIF MARRIED, GIVE MAIDEN NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\nNONE\nPRESENT ADDRESS (Street, city, zone, county, state)\n/\nWileox memorial Hosp. Lihue. Kauai Hawaii\nRELATIONSHIP\nNAME Mrs. AND Rose Alexander. 1320 Convention St. Baton Rouge, La.\nADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nsister\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nDec. 8. 1906.\nYES\nNO\na\nWHAT LANGUAGES DO YOU SPEAK?\nEnglish\nHIGH SCHOOL GRADUATE\nn\nDEGREE OR\nNAME OF COLLEGE OR\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nLOCATION\nn\nUNIVERSITY ATTENDED\nLouisiana state university\n1935-1936\nno.\nacademic\n3 semesters\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nalabama\nNURSES' ASSOCIATION?\n'REGISTERED?\nPRESENT EMPLOYMENT If not employed, check\n1\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nAnesthetist- O.R. Supervisor.\nCITY\nSTATE\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nWillox memorial Storp. Lihue Kauai T.H.\nLehue Kauai\nT.H.\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are wi liing and able to\nserve if called on jithin the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nYES\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\nonly in home community either if\nAttend disaster institutes, if\nYES\nNO\n2. Serve in case\nYES\nNO\nIn other communities avarable ot leine\noffered, in preparation for service\nof disaster\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\n4.\nAccept membership on chapter cóm-\nYES\nYES\nNO\nmittee should services be needed\nprograms, as needed\naide. classes\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nNote!! UNABLE am returing TO SERVE, GIVE to MAJOR themaeland REASONS - in very nearfulture - hence my hexitankay in felling out This\nIF\nDATE\nSIGNATURE\n11-12-45\nStephaine 7. 7oto.\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITRFOLINESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO\nthis\nTHE\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nHamain\nPoBex 3948 Handly\nFORM 1045 Rev. July 1945\n78504M\nN"
}