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Form No. 200
Revised 2-15-18
DUPLICATE
III
AMERICAN RED CROSS
No.
SERVICE ENROLLMENT APPLICATION
=
(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)
Date 5/27/18
a
Mr
The questions should be answered as fully as possible, especially when an application for a passport may later be necessary.
All answers must be in handwriting of applicant.
T
I. Name in full Elizabeth DeLuise Rohrback
s
Telephone No Cathedral 6350
S.
2. Present Address
507 West 111th Street, New York City.
(Number and Street)
(City)
(State)
(a) If any changes of residence since August I, 1914, give these in full with dates.
910 Calumet Av. Chicago, 1914-1917. 1917-1918 519 W. 123 St. N.Y.(
C.
(b) What is your present business or profession? (Be specific.)
Graduate registered nurse
(c) What previous business or professional experience have you had, stating nature, places and principal dates
D
2
thereof?
Have been engaged in Nursing since Sept. 1907. Previous to that
-
P
was bookkeeper in a small coal concern (J.W. Amond Coal Co. Ft.
5
Dodge, Iowa. )
(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided
e
and respective dates of residence in each.
+
Neverlived in Surope
(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.
Never traveled in Europe
(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application
was granted, denied or withdrawn.
5
I
No
a
3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state militi:
C
a
5
C
No
(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of examin-
ing official.
C
Was a member of Unit #13. Resigned to finish work at College.
(b) Were yo11 accepted, rejected, or is result of examination pending?
4. Date of birth 1887
June
25 (a) Place of birth Ft. Pogge, Iowa.
Year
Month
Day
(b) Full name of father
Conrad Rohrback
(c) Birthplace of father Chicago, Ill.
(d) Nationality of father American
(e) If father foreign born, whether naturalized and when
(f) Full maiden name of mother
Mary Hulsizer
(g) Birthplace of mother Madison, Wis
(h) Nationality of mother American
(i) If mother foreign born, whether naturalized and when
(j) Full name and nationality of paternal grandfather Conrad Rohrback - German
(k) Full maiden name and nationality of paternal grandmother Elizabeth Weinrich -Alsace- Lorraine
(1) Full name and nationality of maternal grandfather Hi ram Hulsizer - American
(m) Full maiden name and nationality of maternal grandmother Phoebe Dietz - 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.
As far as I know I have no relatives living in Germany or Europe
any place.
(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.
To the best of knowledge, no member of my family in in war
service for the Allies.
3
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
- 4aa26bddc294e04d
- Size
- unknown
Document data
- ID
- 2661650
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"logicalDate": "1945-11-27",
"month": 11,
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"ocrText": "I I\n&\n0\ne a\nI\n9\na\nForm No. 200\nRevised 2-15-18\nDUPLICATE\nIII\nAMERICAN RED CROSS\nNo.\nSERVICE ENROLLMENT APPLICATION\n=\n(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)\nDate 5/27/18\na\nMr\nThe questions should be answered as fully as possible, especially when an application for a passport may later be necessary.\nAll answers must be in handwriting of applicant.\nT\nI. Name in full Elizabeth DeLuise Rohrback\ns\nTelephone No Cathedral 6350\nS.\n2. Present Address\n507 West 111th Street, New York City.\n(Number and Street)\n(City)\n(State)\n(a) If any changes of residence since August I, 1914, give these in full with dates.\n910 Calumet Av. Chicago, 1914-1917. 1917-1918 519 W. 123 St. N.Y.(\nC.\n(b) What is your present business or profession? (Be specific.)\nGraduate registered nurse\n(c) What previous business or professional experience have you had, stating nature, places and principal dates\nD\n2\nthereof?\nHave been engaged in Nursing since Sept. 1907. Previous to that\n-\nP\nwas bookkeeper in a small coal concern (J.W. Amond Coal Co. Ft.\n5\nDodge, Iowa. )\n(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided\ne\nand respective dates of residence in each.\n+\nNeverlived in Surope\n(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.\nNever traveled in Europe\n(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application\nwas granted, denied or withdrawn.\n5\nI\nNo\na\n3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state militi:\nC\na\n5\nC\nNo\n(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of examin-\ning official.\nC\nWas a member of Unit #13. Resigned to finish work at College.\n(b) Were yo11 accepted, rejected, or is result of examination pending?\n4. Date of birth 1887\nJune\n25 (a) Place of birth Ft. Pogge, Iowa.\nYear\nMonth\nDay\n(b) Full name of father\nConrad Rohrback\n(c) Birthplace of father Chicago, Ill.\n(d) Nationality of father American\n(e) If father foreign born, whether naturalized and when\n(f) Full maiden name of mother\nMary Hulsizer\n(g) Birthplace of mother Madison, Wis\n(h) Nationality of mother American\n(i) If mother foreign born, whether naturalized and when\n(j) Full name and nationality of paternal grandfather Conrad Rohrback - German\n(k) Full maiden name and nationality of paternal grandmother Elizabeth Weinrich -Alsace- Lorraine\n(1) Full name and nationality of maternal grandfather Hi ram Hulsizer - American\n(m) Full maiden name and nationality of maternal grandmother Phoebe Dietz - American\n(n) Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives, if\nany, 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.\nAs far as I know I have no relatives living in Germany or Europe\nany place.\n(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United States,\nspecifying which ally in every case.\nTo the best of knowledge, no member of my family in in war\nservice for the Allies.\n3"
}