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J
ii
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
IT
(To be filled out entirely in applicant's handwriting)
ass,
a
I. Name of applicant Emia
p :
Address The Memorial Hospital Worcester. maes.
a
2.
45 3. Date of birth april 19,1866 Place of birth West Windoor, Vermont.
L
4. Are you married, single or a widow? Single
-
5. Are you a citizen of the United States? yes.
6. Have you any physical defects? slightly deaf.
7.
Education and occupation before entering Training School Common schools of Ut.
followed by his years atan academy nolmnger extant
[Taught School 5 yecus.
8. From what Training School did you graduate?
Noraster City Hosp Training School for Wonester, Nurses
maco.
9. Character of hospital: General? yes, S pecial
Private?
IO. How many beds in hospital at time of graduation? about 80
II. Date of graduation Feb., 1889
Length of course 21. years.
I2. Name and address of Superintendent of Training School under whom you were trained
mrs. Chrissa 4. Pike, Damilson, Comm.
I3. Of what nursing organization are you a member ? mass. State nurses assin.
Novestic City Hosp. alumnae assin Dor: Red Cross Com.)
14.
Give name and address of Secretary miss mand Ridley, 16 Shepard st.
womertic, mass,
15.
Are you a registered nurse? yes
In what State? mass,
Date of
registration November 1910.
I6. How and where have you been employed since graduation? Give information for each year. lay, private muring
2 yestsupt of thuses, Morrislis City Hoaper /yeartSupt: Memorial Hasp. Wonester, 1year. Student
al- college, Cambridge mass. - yet private musing - 14 years supp. Memorial Hosp.
17. Name and permanent address of nearest relati e
S. wordstock, ut.
Signature n.
Date
may 24.1911.
2
-
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"ocrText": "J\nii\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\nIT\n(To be filled out entirely in applicant's handwriting)\nass,\na\nI. Name of applicant Emia\np :\nAddress The Memorial Hospital Worcester. maes.\na\n2.\n45 3. Date of birth april 19,1866 Place of birth West Windoor, Vermont.\nL\n4. Are you married, single or a widow? Single\n-\n5. Are you a citizen of the United States? yes.\n6. Have you any physical defects? slightly deaf.\n7.\nEducation and occupation before entering Training School Common schools of Ut.\nfollowed by his years atan academy nolmnger extant\n[Taught School 5 yecus.\n8. From what Training School did you graduate?\nNoraster City Hosp Training School for Wonester, Nurses\nmaco.\n9. Character of hospital: General? yes, S pecial\nPrivate?\nIO. How many beds in hospital at time of graduation? about 80\nII. Date of graduation Feb., 1889\nLength of course 21. years.\nI2. Name and address of Superintendent of Training School under whom you were trained\nmrs. Chrissa 4. Pike, Damilson, Comm.\nI3. Of what nursing organization are you a member ? mass. State nurses assin.\nNovestic City Hosp. alumnae assin Dor: Red Cross Com.)\n14.\nGive name and address of Secretary miss mand Ridley, 16 Shepard st.\nwomertic, mass,\n15.\nAre you a registered nurse? yes\nIn what State? mass,\nDate of\nregistration November 1910.\nI6. How and where have you been employed since graduation? Give information for each year. lay, private muring\n2 yestsupt of thuses, Morrislis City Hoaper /yeartSupt: Memorial Hasp. Wonester, 1year. Student\nal- college, Cambridge mass. - yet private musing - 14 years supp. Memorial Hosp.\n17. Name and permanent address of nearest relati e\nS. wordstock, ut.\nSignature n.\nDate\nmay 24.1911.\n2\n-"
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