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FORM NO. 1
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
I
(To be filled out entirely in applicant's handwriting)
e
1. Name of applicant
lielen Fletcher lettener
Badge Number
le
2. Address in full
7eb22nd 1888 Place of birth Garleton Pluce Out leaw.
37 East 21st. St n.ef City
5
3. Date of birth
F
4. Are you married, single or a widow?
Are you a citizen of the United States? no
5. Have you any physical defects?
no
6. Occupation before entering Training School
now
7. From what Training School did you graduate? Preskyteris Happ Date may 1913
8. Give location of Training School
new york City 37Enla St.
9. Character of hospital: General
Special ?
Private?
10. Average number of patients in hospital during training
Length of course 3 years
11. Name and address of Superintendent of Training School under whom you were trained
miss A.C. maxwell 878.7121st.
12. Of what nursing organizations are you a
member? alumine assue.
Pridyterian Hop
13. Give name and address of Secretary
miss Eleza m night
humorial Hosp. morristourn not
14. Are you a registered nurse? yes In what State? n.y. Date of registration June l 913
15. How and where have you been employed since graduation? Give information for each year
16. In the event of war are you willing to take the required oath of allegiance ? yes
17. Name and permanent address of relative Grs. Elizabeth Latiner (mothia)
nearest
c/o lerlin m=2utosh burleton Pluce lut.com
Date
Signature
Helm Hetcher Latanes.
This blank to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee
to
be forwarded with "credentials" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c.
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Document data
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"ocrText": "+\nin\ne\nFORM NO. 1\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\nI\n(To be filled out entirely in applicant's handwriting)\ne\n1. Name of applicant\nlielen Fletcher lettener\nBadge Number\nle\n2. Address in full\n7eb22nd 1888 Place of birth Garleton Pluce Out leaw.\n37 East 21st. St n.ef City\n5\n3. Date of birth\nF\n4. Are you married, single or a widow?\nAre you a citizen of the United States? no\n5. Have you any physical defects?\nno\n6. Occupation before entering Training School\nnow\n7. From what Training School did you graduate? Preskyteris Happ Date may 1913\n8. Give location of Training School\nnew york City 37Enla St.\n9. Character of hospital: General\nSpecial ?\nPrivate?\n10. Average number of patients in hospital during training\nLength of course 3 years\n11. Name and address of Superintendent of Training School under whom you were trained\nmiss A.C. maxwell 878.7121st.\n12. Of what nursing organizations are you a\nmember? alumine assue.\nPridyterian Hop\n13. Give name and address of Secretary\nmiss Eleza m night\nhumorial Hosp. morristourn not\n14. Are you a registered nurse? yes In what State? n.y. Date of registration June l 913\n15. How and where have you been employed since graduation? Give information for each year\n16. In the event of war are you willing to take the required oath of allegiance ? yes\n17. Name and permanent address of relative Grs. Elizabeth Latiner (mothia)\nnearest\nc/o lerlin m=2utosh burleton Pluce lut.com\nDate\nSignature\nHelm Hetcher Latanes.\nThis blank to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee\nto\nbe forwarded with \"credentials\" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c."
}