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Form No. 200
Revised 2-15-18
3770
DUPLICATE.
AMERICAN RED CROSS
No.
SERVICE ENROLLMENT APPLICATION
Date
(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)
The questions should be answered as fully as possible, especially when an application for a passport may later be necessary.
HOAGLAND. ha of applicant,
West 4960
I. Name in full
618-8.Spaulding
Chicagelephone No
Illinots.
2. Present Address
(Number and Street)
(City)
(State)
(a) If any 3036 of 154 sith 1916,3302
Flourney St. 1917
(b) What hicago.
(c) What previous business or professional experience have you had, stating nature, places and principal
datesIthersof Training School for Nurses Aug. 185,1908 to Sept.8,1911
Head- Nurse, Mens Surgical Ward; Sept.8-Mar 1/10. Supervisor
Rooms Glenville Bosp. Cleveland, 0. Jun 1912-Aug.1,1914.Supervisor
of Ear, Nose and Throat Dept. Cook Co. Hosp. Sept. 1/14 to June 1/15.
(d) Have you ever lived in Europe? If so, give hametor Eutopean Ccoukt iesDie Hwhich youne date
and respective dates of residence in each.
(e) Have you ever traveled in Europe? If so; name countries visited, with respective dates of visits.
(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application
wasggranted, denied or withdrawn.
3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state
militia.
H
-
(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of ex-
amining official.
(b) Were you accepted, rejected, or is result of examination pending?
1884
June
1st
Logansport, Ind.
4. Date of birth
(a) Place of birth
Year
Edward Moagland,
(b) Full name of father
New York State
American
(c) Birthplace of father
(d) Natioriality of father
(e) If father foreign born, whether dhfsonlaugh,
(f) Full maiden name of mothridiana
(g) Birthplace of mother
(h) Nationality of mother
(i) If mother foreign born, whether naturalized and when
Abraham Koagland, ,American
(j)
Full name and nationality of paternal grandfather
Cornelia VanBuskirk, American
(k) Full maiden name and nationality of paternal grandmother
John
II
Johnsonlaugh, Americar
(1) Full name and nationality of maternal grand father
(m) Full maiden name and nationality of maternal grandmother
Sarah Shafer,American
(n)
Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives,
if any, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State
nature and places of employment of each of such relatives not now in such war service.
3
(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United
States, specifying which ally in every case.
Page data
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- Source index
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Document data
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- Core
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Context sent to Scholar
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"ocrText": "Form No. 200\nRevised 2-15-18\n3770\nDUPLICATE.\nAMERICAN RED CROSS\nNo.\nSERVICE ENROLLMENT APPLICATION\nDate\n(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)\nThe questions should be answered as fully as possible, especially when an application for a passport may later be necessary.\nHOAGLAND. ha of applicant,\nWest 4960\nI. Name in full\n618-8.Spaulding\nChicagelephone No\nIllinots.\n2. Present Address\n(Number and Street)\n(City)\n(State)\n(a) If any 3036 of 154 sith 1916,3302\nFlourney St. 1917\n(b) What hicago.\n(c) What previous business or professional experience have you had, stating nature, places and principal\ndatesIthersof Training School for Nurses Aug. 185,1908 to Sept.8,1911\nHead- Nurse, Mens Surgical Ward; Sept.8-Mar 1/10. Supervisor\nRooms Glenville Bosp. Cleveland, 0. Jun 1912-Aug.1,1914.Supervisor\nof Ear, Nose and Throat Dept. Cook Co. Hosp. Sept. 1/14 to June 1/15.\n(d) Have you ever lived in Europe? If so, give hametor Eutopean Ccoukt iesDie Hwhich youne date\nand respective dates of residence in each.\n(e) Have you ever traveled in Europe? If so; name countries visited, with respective dates of visits.\n(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application\nwasggranted, denied or withdrawn.\n3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state\nmilitia.\nH\n-\n(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of ex-\namining official.\n(b) Were you accepted, rejected, or is result of examination pending?\n1884\nJune\n1st\nLogansport, Ind.\n4. Date of birth\n(a) Place of birth\nYear\nEdward Moagland,\n(b) Full name of father\nNew York State\nAmerican\n(c) Birthplace of father\n(d) Natioriality of father\n(e) If father foreign born, whether dhfsonlaugh,\n(f) Full maiden name of mothridiana\n(g) Birthplace of mother\n(h) Nationality of mother\n(i) If mother foreign born, whether naturalized and when\nAbraham Koagland, ,American\n(j)\nFull name and nationality of paternal grandfather\nCornelia VanBuskirk, American\n(k) Full maiden name and nationality of paternal grandmother\nJohn\nII\nJohnsonlaugh, Americar\n(1) Full name and nationality of maternal grand father\n(m) Full maiden name and nationality of maternal grandmother\nSarah Shafer,American\n(n)\nNames of all relatives nearer than second cousins living in Europe, specifying which of said relatives,\nif any, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State\nnature and places of employment of each of such relatives not now in such war service.\n3\n(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United\nStates, specifying which ally in every case."
}