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F 0 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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    "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"
}