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Form 1037
Rev. Jan., 1941
AMERICAN RED CROSS NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out in applicant's handwriting and each question answered fully)
1. Name of applicant in full gestrude Hughes. handmisser
Date of birth 4- 4.1897.
(Month)
(Day)
(Year)
If married, give maiden name
2. Permanent address
(Street)
Probable address for one year 19th swetam
(Street)
Harrishing (City) (County) Damphin.) (State) Pa. -
(City)
(County)
(State)
3. Race W.
Place of birth willis Barre. Pa. U.S.A Marital status Single
(single, marfied, widowed or divorced)
Birthplace of father U.S.A.
Mother U.S.A.
Citizenship of father U.S.A
Are you a citizen of the United States?
yes.
4. GENERAL EDUCATION (prior to entering nursing) :
No. of years
Did you graduate?
attendance
Yes or No
High school
4
yes
Normal school
College or University
Other
What languages other than English do you speak?
none
(Underline those which you speak fluently)
5. PROFESSIONAL EDUCATION:
a. School of Nursing from which you graduated:
Jurish Hospital
Philadelphia
Pa
(Name)
Date of graduation may - 30 th 1918
(City)
(State)
Length of course
3 yes
-
1919
Character of hospital: General or special
general -
Daily average
No. of patients
300
during training
In this hospital, which services did you receive experience in as segregated services: (underline)
Eye, Ear Communicable
Outpatient
Medicine-Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases -Psychiatry-Department
In this hospital, which services did you receive experience in as non-segregated services: (underline)
Eye, Ear Communicable
Outpatient
Medicine-Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases Psychiatry-Department
b. Undergraduate affiliations:
Hospital or Organization
Clinical
City and State
specialty
No. months
(1) unity nurse Sourty
Philadelpha
Public Health
2 math -
(2)
(3)
c. Postgraduate clinical or field courses (Do not include academic work.)
Hospital or Organization
Clinical
City and State
specialty
No. months
(1)
(2)
(3)
d. Academic study since graduation from School of Nursing:
College or University
City and State
Nature of work
No. months
(1) Pa. School of social Healthwank Philadelphia Pa.
Public Health
9- -
(2) University of Pa. Philadelphia Pa
is
"
Part teace wale-
(3)
EXBERTENCE
(OVER)
Page data
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- Source index
- 0
- Type
- photo
- Media ID
- 300cb864687a1b8b
- Size
- unknown
Document data
- ID
- 2661795
- Core
- doc
- Type
- document
DTO data
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"ocrText": "Form 1037\nRev. Jan., 1941\nAMERICAN RED CROSS NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out in applicant's handwriting and each question answered fully)\n1. Name of applicant in full gestrude Hughes. handmisser\nDate of birth 4- 4.1897.\n(Month)\n(Day)\n(Year)\nIf married, give maiden name\n2. Permanent address\n(Street)\nProbable address for one year 19th swetam\n(Street)\nHarrishing (City) (County) Damphin.) (State) Pa. -\n(City)\n(County)\n(State)\n3. Race W.\nPlace of birth willis Barre. Pa. U.S.A Marital status Single\n(single, marfied, widowed or divorced)\nBirthplace of father U.S.A.\nMother U.S.A.\nCitizenship of father U.S.A\nAre you a citizen of the United States?\nyes.\n4. GENERAL EDUCATION (prior to entering nursing) :\nNo. of years\nDid you graduate?\nattendance\nYes or No\nHigh school\n4\nyes\nNormal school\nCollege or University\nOther\nWhat languages other than English do you speak?\nnone\n(Underline those which you speak fluently)\n5. PROFESSIONAL EDUCATION:\na. School of Nursing from which you graduated:\nJurish Hospital\nPhiladelphia\nPa\n(Name)\nDate of graduation may - 30 th 1918\n(City)\n(State)\nLength of course\n3 yes\n-\n1919\nCharacter of hospital: General or special\ngeneral -\nDaily average\nNo. of patients\n300\nduring training\nIn this hospital, which services did you receive experience in as segregated services: (underline)\nEye, Ear Communicable\nOutpatient\nMedicine-Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases -Psychiatry-Department\nIn this hospital, which services did you receive experience in as non-segregated services: (underline)\nEye, Ear Communicable\nOutpatient\nMedicine-Surgery-Pediatrics-Obstetrics-Nose & Throat- Diseases Psychiatry-Department\nb. Undergraduate affiliations:\nHospital or Organization\nClinical\nCity and State\nspecialty\nNo. months\n(1) unity nurse Sourty\nPhiladelpha\nPublic Health\n2 math -\n(2)\n(3)\nc. Postgraduate clinical or field courses (Do not include academic work.)\nHospital or Organization\nClinical\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nd. Academic study since graduation from School of Nursing:\nCollege or University\nCity and State\nNature of work\nNo. months\n(1) Pa. School of social Healthwank Philadelphia Pa.\nPublic Health\n9- -\n(2) University of Pa. Philadelphia Pa\nis\n\"\nPart teace wale-\n(3)\nEXBERTENCE\n(OVER)"
}