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Form No. 200 Revised 6-4-20 AMERICAN RED CROSS Superseding Form 249 and com E bining with previous issue of Form 200. SERVICE APPLICATION FORM All these questions must be answered fully or the application will not be acted upon. a Date. April 6-1923 1. Name in full Fox , Elizabeth Gordan Telephone No 2. Permanent address - St. N. W. Woshinglon D.C. (Number and Street) (City) (State) 3. Temporary address, if any, to what date (Number and Street) (City) (State) 4. Name, address, and relationship of person to be notified in case of emergency Mother Mrs Edwin M.Fox Same address. telefobanc as that given. above (Name) (Number and Street) (City) (State) 0 5. (Relationship) (a) Date of birth. 1884 Dec 2nd (b) Place of birth Milwaukee Wisconsin 1 (Year) (Month) (Day) - a (c) If foreign born, when and where did you arrive in U. S - on 0 6. If foreign born, give date and court of your naturalization 7. (a) Single, married, widowed, divorced Single (b) Number of dependents One - (c) Full name of wife before marriage; or husband (d) Birthplace of wife or husband - Nationality of wife or husband - (e) Birthplace and nationality of father of wife or husband - (f) Birthplace and nationality of mother of wife or husband (g) Full name of father Edwin M. Fox Birthplace and nationality of father farm near. Madison Wiscunsin american (h) (i) If father foreign born, whether naturalized, when and where. 1 (j) Full maiden name of mother Frances Gordon (k) Birthplace and nationality of mother Madiion Wisconsin amexican. - (1) If mother foreign born, whether naturalized, when and where (m) Full name and nationality of paternal grand nather Matthew Fox lvish (o) Full name and nationality of maternal grandfather Willard. Ira Gordon American (Scotch descent (n) Full maiden name and nationality of paternal grandmother Elizabeth Jane Fletcher (rish (p) Full maiden name and nationality of maternal grandmother bucy Ann Garlick " (English " 1 8. State schools and colleges attended, with year of graduation and degrees taken University of Wisconsin 1907 A.B.- Madison Wisconsin Johns. Hopkins. School for Nurses Baltimone maryland (Location) (Graduated) (Degree) 9. What is (Name) your present business or profession Director Public Health Nursing Service Name of firm or corporation with which associated american Red Cross Duration of service. 5 years Present capacity Business address american Recl. Gross Washung lon D.C. (Number and Street) (City) (State) 10. (a) What previous business or professional experience have you had? University Hospital Minneoholis 1911-1912 Head Savqical nurse Visiting Masse asson. Chicago III. 1912-1913 Staff Nuvse " " Dayton phio 1913-1915 " " " Washington.CC 1415-1919 Red.Cross " " 1919 - Director Tublic. Hea ITh Nursing (Company) (Location) (from-to) (Nature of work) 11. As reference, give names and addresses of three American citizens not related to you Cheuy chase mcl. Mrs. Whitman Cross Breekville Read of Ekick Washington D.C. Miss Mary Gardner MainSt Providence Thode Island. Mrs Charles Vilas Hotel Biltmore (Name) (Number and Street) (City) N.Y. (State)

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    "ocrText": "Form No. 200\nRevised 6-4-20\nAMERICAN RED CROSS\nSuperseding Form 249 and com\nE\nbining with previous issue of\nForm 200.\nSERVICE APPLICATION FORM\nAll these questions must be answered fully or the application will not be acted upon.\na\nDate. April 6-1923\n1. Name in full Fox , Elizabeth Gordan\nTelephone No\n2. Permanent address\n- St. N. W. Woshinglon\nD.C.\n(Number and Street)\n(City)\n(State)\n3. Temporary address, if any, to what date\n(Number and Street)\n(City)\n(State)\n4. Name, address, and relationship of person to be notified in case of emergency\nMother\nMrs Edwin M.Fox\nSame address. telefobanc as that given. above\n(Name)\n(Number and Street)\n(City)\n(State)\n0\n5. (Relationship) (a) Date of birth. 1884\nDec\n2nd (b) Place of birth Milwaukee Wisconsin\n1\n(Year)\n(Month)\n(Day)\n-\na\n(c) If foreign born, when and where did you arrive in U. S\n-\non\n0\n6. If foreign born, give date and court of your naturalization\n7. (a) Single, married, widowed, divorced\nSingle\n(b) Number of dependents One\n-\n(c) Full name of wife before marriage; or husband\n(d) Birthplace of wife or husband\n-\nNationality of wife or husband\n-\n(e) Birthplace and nationality of father of wife or husband\n-\n(f) Birthplace and nationality of mother of wife or husband\n(g) Full name of father Edwin M. Fox\nBirthplace and nationality of father farm near. Madison Wiscunsin\namerican\n(h)\n(i) If father foreign born, whether naturalized, when and where. 1\n(j) Full maiden name of mother Frances Gordon\n(k) Birthplace and nationality of mother\nMadiion Wisconsin\namexican.\n-\n(1) If mother foreign born, whether naturalized, when and where\n(m) Full name and nationality of paternal grand nather\nMatthew Fox\nlvish\n(o) Full name and nationality of maternal grandfather Willard. Ira Gordon American (Scotch descent\n(n) Full maiden name and nationality of paternal grandmother Elizabeth Jane Fletcher (rish\n(p) Full maiden name and nationality of maternal grandmother bucy Ann Garlick \"\n(English \" 1\n8. State schools and colleges attended, with year of graduation and degrees taken\nUniversity of Wisconsin\n1907 A.B.-\nMadison Wisconsin\nJohns. Hopkins. School for Nurses\nBaltimone maryland\n(Location)\n(Graduated)\n(Degree)\n9. What is (Name) your present business or profession Director Public Health Nursing Service\nName of firm or corporation with which associated\namerican Red Cross\nDuration of service. 5 years\nPresent capacity\nBusiness address\namerican Recl. Gross\nWashung lon\nD.C.\n(Number and Street)\n(City)\n(State)\n10. (a) What previous business or professional experience have you had?\nUniversity Hospital Minneoholis\n1911-1912\nHead Savqical nurse\nVisiting Masse asson. Chicago III. 1912-1913\nStaff Nuvse\n\"\n\"\nDayton phio 1913-1915\n\"\n\"\n\"\nWashington.CC 1415-1919\nRed.Cross\n\"\n\"\n1919\n-\nDirector Tublic. Hea ITh Nursing\n(Company)\n(Location)\n(from-to)\n(Nature of work)\n11. As reference, give names and addresses of three American citizens not related to you\nCheuy chase\nmcl.\nMrs. Whitman Cross Breekville Read of Ekick\nWashington\nD.C.\nMiss Mary Gardner\nMainSt\nProvidence\nThode Island.\nMrs Charles Vilas\nHotel Biltmore\n(Name)\n(Number and Street)\n(City)\nN.Y. (State)"
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