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D.M.R.1
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
1. Name of applicant in full
Stella Govetray
Temporary
2. Address in full
Permanent 238 Webster St, East Batton, mass
509 121 St. new york, n.y.
w.
14th
3. Date of birth
July 8, 1886
Race White Place of birth East Brston, mass.
Birthplace of father
England
Mother
Canada
Citizenship of father
United States
4. Are you married, single or a widow?
Suigle
Are you a citizen of the United States?
yes
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
no
Are you physically strong and healthy ?
yes
6. How many years have you attended grammar school? 9
High school? 3
Normal school?
-
Private school?
College?
/
If tutored privately, name subjects covered and length of time
thench, English, Algeha Latin almt 6 mrs in Each
7. What languages other than English do you speak?
none
8. Occupation before entering training school Secretary and assistant to Editor
9. From what hospital training school did you receive your diploma? the Children's Hospital
City and State
Boston, muss
Stilla Goostray
Date of graduation Jan 21, 1920
Give name at time of graduation
10. Character of hospital: General?
-
Special? yes
Private? -
11. Did your training include obstetrics ? yes Care of men? yes Children? yes Contagious diseases?
-
12. Daily average number of patients in hospital during training
135
Length
of course 3 years
13. Name and address of superintendent of training school under whom you received training
Elizabeth E Sullivan 10 Bradfud air Bradford mass.
14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
ok mass. General Boston, 4 mos. manhatten materinity, new York, 3 mos,
15. Of what nursing organizations are you a member?
The Children's strapetal Almmule association Britin miss
16. Which, if any, is affiliated with the American Nurses Association?
alumnae are
17. Give name and address of secretary of at least one of these organizations
Christive metskelson., 300 Longuard am Broton Lee alumna 7th assoc
18. Are you a registered nurse ! year In what state? mass Date of registration hunchia 1920Number 995Y hut yut recid
19. How and where employed since graduation:
Give dates with months
Name and address of employers
Student, Teachers' College.
Jul.1920 -
nursing? Health Dept (Instructors in
(Present position)
ny
Training School Division)
20. Check services in which you are willing to serve and underscore one preferred.
(a) War Service
Wherever needed.
Marine Hospitals
(b) Public Health War Service: Sanitary Zones.
Wherever needed.
Public Health Nursing in Town and Country Nursing Service.
21. Upon what date will you be available for service?
Whenever needed
22. Are you willing to take the oath of allegiance?
yes
23. Name and permanent address of nearest relative
Job Goostray (father)
238 Urbster St. East Bratin, muss
Telephone East Bratm 39.3 lu
Date
may 1920
Signature of nurse
Salla Goostray
To the Committee
This 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.
703. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval
and endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 29 and 11, should be
forwarded through the Director of the Bureau of Nursing in your Division Office to the Department of Nursing, American
Red Cross, Washington, D. C.
In case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to
the Local Committee, instead of to Washington as instructed, such forms should be forwarded at once to Washington by
the Local Committee, from whence credentials will be procured.
NOTE-Nurses who have had training or experience in Public Health Nursing will, in addition
to the above, fill out questions 24 to 31 on reverse side of this blank.
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"ocrText": "D.M.R.1\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1. Name of applicant in full\nStella Govetray\nTemporary\n2. Address in full\nPermanent 238 Webster St, East Batton, mass\n509 121 St. new york, n.y.\nw.\n14th\n3. Date of birth\nJuly 8, 1886\nRace White Place of birth East Brston, mass.\nBirthplace of father\nEngland\nMother\nCanada\nCitizenship of father\nUnited States\n4. Are you married, single or a widow?\nSuigle\nAre you a citizen of the United States?\nyes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno\nAre you physically strong and healthy ?\nyes\n6. How many years have you attended grammar school? 9\nHigh school? 3\nNormal school?\n-\nPrivate school?\nCollege?\n/\nIf tutored privately, name subjects covered and length of time\nthench, English, Algeha Latin almt 6 mrs in Each\n7. What languages other than English do you speak?\nnone\n8. Occupation before entering training school Secretary and assistant to Editor\n9. From what hospital training school did you receive your diploma? the Children's Hospital\nCity and State\nBoston, muss\nStilla Goostray\nDate of graduation Jan 21, 1920\nGive name at time of graduation\n10. Character of hospital: General?\n-\nSpecial? yes\nPrivate? -\n11. Did your training include obstetrics ? yes Care of men? yes Children? yes Contagious diseases?\n-\n12. Daily average number of patients in hospital during training\n135\nLength\nof course 3 years\n13. Name and address of superintendent of training school under whom you received training\nElizabeth E Sullivan 10 Bradfud air Bradford mass.\n14. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nok mass. General Boston, 4 mos. manhatten materinity, new York, 3 mos,\n15. Of what nursing organizations are you a member?\nThe Children's strapetal Almmule association Britin miss\n16. Which, if any, is affiliated with the American Nurses Association?\nalumnae are\n17. Give name and address of secretary of at least one of these organizations\nChristive metskelson., 300 Longuard am Broton Lee alumna 7th assoc\n18. Are you a registered nurse ! year In what state? mass Date of registration hunchia 1920Number 995Y hut yut recid\n19. How and where employed since graduation:\nGive dates with months\nName and address of employers\nStudent, Teachers' College.\nJul.1920 -\nnursing? Health Dept (Instructors in\n(Present position)\nny\nTraining School Division)\n20. Check services in which you are willing to serve and underscore one preferred.\n(a) War Service\nWherever needed.\nMarine Hospitals\n(b) Public Health War Service: Sanitary Zones.\nWherever needed.\nPublic Health Nursing in Town and Country Nursing Service.\n21. Upon what date will you be available for service?\nWhenever needed\n22. Are you willing to take the oath of allegiance?\nyes\n23. Name and permanent address of nearest relative\nJob Goostray (father)\n238 Urbster St. East Bratin, muss\nTelephone East Bratm 39.3 lu\nDate\nmay 1920\nSignature of nurse\nSalla Goostray\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.\n703. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval\nand endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10, 29 and 11, should be\nforwarded through the Director of the Bureau of Nursing in your Division Office to the Department of Nursing, American\nRed 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\nthe Local Committee, instead of to Washington as instructed, such forms should be forwarded at once to Washington by\nthe Local Committee, from whence credentials will be procured.\nNOTE-Nurses who have had training or experience in Public Health Nursing will, in addition\nto the above, fill out questions 24 to 31 on reverse side of this blank."
}