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For Office Use Only
III
FORM 1219
REV. AUG. 1941
Date Auth
AMERICAN RED CROSS
Type of Auth
11)_
A.R.C. MAIL ROOM
Chapter
Return
APPLICATION FORM
Nursing Service
State
FOR EERVICE IN HAWAII
wis
ARC
and
MAY 1 81942
Confidential
and
RED CROSS MOME NURSINO INSTRUCTOR
M
Please return
I. PERSONAL
Date may 16,42
-
Name in full miss mollie Badge (No. (H.D. 68,970
(MISS OR MRS)
GIF MARRIED, GIVE MAIPEN NAME)
Present address 12 Scott, (STREET) Wayland (SITY) newyork (STATE) Tel. No
Not enrolled
Permanent address 1046 (STREET) Ferry (CITY) Easton Pennetor. (STATE) No 2-02/12
K
Date
of birth 4/10/13
Marital status
Single
a
Race W hite
(SINGLE, WIDOWED, DIVORCED)
+
Citizenship
american
II. EDUCATION
1. Prior to entering school of nursing
Diploma
Name
City and State
Dates
of
or Degree
Major
Normal High School School Easton High Caston Pa 1926-1930 Deploma Heatory
or University
Other
BIBAC
2. School of nursing from which you graduated
Predites
Name Easton Hospital School of nursing
Location caston, (CITY Penna Date of graduation 19341 Length of course 3 years
AND STATE)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
affiliations not necessary
4. Academic study since graduation from school of nursing
:
College or University or
Diploma
postgraduate course
City and State No Months or Degree
Major
Simmons College
Boston, mass amo certificate P.N.N.
add
aldriw
What courses in principles of teaching have you had?
Have you had a course ip practice teaching?
methods of teaching -
Do Do you hold a state teacher's certificate? nurse-Leacher Where newyork state
you speak a foreign language?
no
(Over)
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"ocrText": "-\nFor Office Use Only\nIII\nFORM 1219\nREV. AUG. 1941\nDate Auth\nAMERICAN RED CROSS\nType of Auth\n11)_\nA.R.C. MAIL ROOM\nChapter\nReturn\nAPPLICATION FORM\nNursing Service\nState\nFOR EERVICE IN HAWAII\nwis\nARC\nand\nMAY 1 81942\nConfidential\nand\nRED CROSS MOME NURSINO INSTRUCTOR\nM\nPlease return\nI. PERSONAL\nDate may 16,42\n-\nName in full miss mollie Badge (No. (H.D. 68,970\n(MISS OR MRS)\nGIF MARRIED, GIVE MAIPEN NAME)\nPresent address 12 Scott, (STREET) Wayland (SITY) newyork (STATE) Tel. No\nNot enrolled\nPermanent address 1046 (STREET) Ferry (CITY) Easton Pennetor. (STATE) No 2-02/12\nK\nDate\nof birth 4/10/13\nMarital status\nSingle\na\nRace W hite\n(SINGLE, WIDOWED, DIVORCED)\n+\nCitizenship\namerican\nII. EDUCATION\n1. Prior to entering school of nursing\nDiploma\nName\nCity and State\nDates\nof\nor Degree\nMajor\nNormal High School School Easton High Caston Pa 1926-1930 Deploma Heatory\nor University\nOther\nBIBAC\n2. School of nursing from which you graduated\nPredites\nName Easton Hospital School of nursing\nLocation caston, (CITY Penna Date of graduation 19341 Length of course 3 years\nAND STATE)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\naffiliations not necessary\n4. Academic study since graduation from school of nursing\n:\nCollege or University or\nDiploma\npostgraduate course\nCity and State No Months or Degree\nMajor\nSimmons College\nBoston, mass amo certificate P.N.N.\nadd\naldriw\nWhat courses in principles of teaching have you had?\nHave you had a course ip practice teaching?\nmethods of teaching -\nDo Do you hold a state teacher's certificate? nurse-Leacher Where newyork state\nyou speak a foreign language?\nno\n(Over)"
}