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D. M. R. I.
K
THE AMERICAN RED CROSS
NURSING SERVICE
0
e
5
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
x
9
1.
Name
of
applicant in full Lydia Areng
2. Address in full, Street. A18 East 6th City Abilene, of State gansas
D
31
3. Date of birth afe 21-1887
Place of birth Colomon.Rano
4. Are you married, single or a widow?
Are you a citizen of the United States? yes
a
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
no
Are you physically strong and healthy? yes
6. Name educational institutions attended before entering training school, stating number of years at each and from
which you were graduated 8th Grade Grammar school. 6 mo
Course of Domestic Science, Kansas, state agricultural College manhattan Kans.
7. What languages other than English do you speak?
8. Occupation before entering training school Domestic & dressmaking
9. From what hospital training school did you receive your diploma?
City and state Kansas City mo
Date of graduation ang 19 1918
University Harp
10. Character of hospital: General?
Special?
Private?
11. Did your training include obstetrics? yes Care of men? yes 50 Children? yes Contagious diseases? yes
12. Daily average number of patients in hospital during training Length of course 3 yrs
13. Name and address of superintendent of training school under whom you received training
miss Alive m Bayer 1005 Campbell St. IT.C mo
14. If your training as a nurse was received in more than one hospital, give Name, location and time spent in each
15. Of what nursing organizations are you a member?
16. which, if any, is affiliated with the American Nurses Association?
17. Give name and address of secretary of at least one of these organizations
18. Are you a registered nurse? yes In what state? mo Date of registration June 1918 Number 2970
19. How and where employed since graduation?
Give dates with months.
Name and address of employer:
(Specify for which of the following services you wish, to be considered.)
20. War Instructor, Are Elementary Hygiene yes
service, wherever needed Contonment When available after
you willing to take the oath of allegiance?
21.
22. Public Health Nursing
In Town and Country Nursing Service
or for War Service
U
23.
Name and permanent address of nearest relative many h. Koeing
418 Eleth Sl ablene, Kays
5
Date July 9, 1918
Signature of Nurse hydia Koung
5
To the Committee:
0
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. 150. 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 and 11,
should be forwarded to the Chairman, National Committee on Nursing Service, 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 Washing-
ton by the Local Committee, from whence credentials will be procured.
I REQ. have 18-2125B taken 2M Eeb. the state Board Exam. Returns not get received.
State Brard returns, need. noted aloor.
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Document data
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- Core
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- Type
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"ocrText": "D. M. R. I.\nK\nTHE AMERICAN RED CROSS\nNURSING SERVICE\n0\ne\n5\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\nx\n9\n1.\nName\nof\napplicant in full Lydia Areng\n2. Address in full, Street. A18 East 6th City Abilene, of State gansas\nD\n31\n3. Date of birth afe 21-1887\nPlace of birth Colomon.Rano\n4. Are you married, single or a widow?\nAre you a citizen of the United States? yes\na\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno\nAre you physically strong and healthy? yes\n6. Name educational institutions attended before entering training school, stating number of years at each and from\nwhich you were graduated 8th Grade Grammar school. 6 mo\nCourse of Domestic Science, Kansas, state agricultural College manhattan Kans.\n7. What languages other than English do you speak?\n8. Occupation before entering training school Domestic & dressmaking\n9. From what hospital training school did you receive your diploma?\nCity and state Kansas City mo\nDate of graduation ang 19 1918\nUniversity Harp\n10. Character of hospital: General?\nSpecial?\nPrivate?\n11. Did your training include obstetrics? yes Care of men? yes 50 Children? yes Contagious diseases? yes\n12. Daily average number of patients in hospital during training Length of course 3 yrs\n13. Name and address of superintendent of training school under whom you received training\nmiss Alive m Bayer 1005 Campbell St. IT.C mo\n14. If your training as a nurse was received in more than one hospital, give Name, location and time spent in each\n15. Of what nursing organizations are you a member?\n16. which, if any, is affiliated with the American Nurses Association?\n17. Give name and address of secretary of at least one of these organizations\n18. Are you a registered nurse? yes In what state? mo Date of registration June 1918 Number 2970\n19. How and where employed since graduation?\nGive dates with months.\nName and address of employer:\n(Specify for which of the following services you wish, to be considered.)\n20. War Instructor, Are Elementary Hygiene yes\nservice, wherever needed Contonment When available after\nyou willing to take the oath of allegiance?\n21.\n22. Public Health Nursing\nIn Town and Country Nursing Service\nor for War Service\nU\n23.\nName and permanent address of nearest relative many h. Koeing\n418 Eleth Sl ablene, Kays\n5\nDate July 9, 1918\nSignature of Nurse hydia Koung\n5\nTo the Committee:\n0\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.\nR.\nC. 150. Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after\napproval and endorsement by Local Committee, with credentials (Forms 3 and 4), together with Forms 10 and 11,\nshould be forwarded to the Chairman, National Committee on Nursing Service, American Red 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 Washing-\nton by the Local Committee, from whence credentials will be procured.\nI REQ. have 18-2125B taken 2M Eeb. the state Board Exam. Returns not get received.\nState Brard returns, need. noted aloor."
}