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Form 1037
31
4-23-24
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
T
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1. Name of
applicant in full Geace mildred reading
0
158 Bancroft Park
2. Address in full
Hopedale mass.
24
3. Date of birth October 15,1901 Race W hite Place of birth milford mass
Birthplace of father. nova Scotia Mother United States Citizenship of father american.
4.
Are you married, single or a widow ? single Are you a citizen of the United States ? yes
5.
How many years have you attended grammar school 9 High school ? 4
Normal
school
?
0
Private school ? 0 College ? 0 if tutored privately, name subjects covered and length of time
6. What languages other than English do you speak ?
none
(Underline those which you speak fluently)
7.
Occupation before entering training school
student
8.
From what hospital training school did you receive your diploma ?
City and State W orcester mass.
City Hospital
Date of graduation
Give name at time of graduation Deau m Durling
may 2, 1922
a
9. Character hospital: General ? yes
of
Special ?
Private ?
10.
Did your training include obstetrics yes Care of men ? up Children ? yes Contagious diseases? yes
<
11. Daily average number of patients in Hospital during trainingé 255:5-286 293.12 Length of course 3 years
us
t
12. Name and address of superintendent of nurses under whom you received training. mins gene
C
V.B Yan Pelt,
11
13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
Belmont Hospital, Workster man 2 months
14.
mass. state nurses asso
Of what nursing organizations are you a member ? Woulster City Hospital alumnae
15. Which, if any, is affiliated with the American Nurses' Association ? mass. State nurses ass.
16.
Give name and address of secretary of at least one of these organizations mrs Lrank Wessel
3/5 Pleasant street Worcester mass.
17. Are you a registered nurse yes in what State ? mass Date of registration Number 11651
18. Type of work and length of service since graduation:
Institutional supervisor for eeven months.
Private duty for two years
Public Health work for overear
(Present position)
Public Health-
19.
Will you be willing to accept active service if the United States becomes involved in war? yes
20. (a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing, Instructor,
Home Hygiene and Care of Sick, Army, Navy U. S. Public Health Service, U. S. Veterans Bureau.
(b)
Date
upon
which you will be available where called
21. Are you willing to take the oath of allegiance ? yes
22. Name and permanent address of near relative
58 Baneroft Park, Hopedale mass- Father
(give relationship) Mrs. James H. Durling
Date
NOTE Nurses who have had training or experience in Public Health Nursing will, in addition to the above, out questions
April 3,1926 Signature of nurse Grace m Durling fill
23 and 24 on reverse side of this blank.
To The Committee:
This blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.
703. Application forms after approval and endorsement by Local committee, with Forms 1244, 1189, 1193 should
be forwarded to the Director of the Nursing Service in your Division Office.
HEYTIH
a
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Document data
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"ocrText": "I\nite\ne-\nForm 1037\n31\n4-23-24\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nT\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1. Name of\napplicant in full Geace mildred reading\n0\n158 Bancroft Park\n2. Address in full\nHopedale mass.\n24\n3. Date of birth October 15,1901 Race W hite Place of birth milford mass\nBirthplace of father. nova Scotia Mother United States Citizenship of father american.\n4.\nAre you married, single or a widow ? single Are you a citizen of the United States ? yes\n5.\nHow many years have you attended grammar school 9 High school ? 4\nNormal\nschool\n?\n0\nPrivate school ? 0 College ? 0 if tutored privately, name subjects covered and length of time\n6. What languages other than English do you speak ?\nnone\n(Underline those which you speak fluently)\n7.\nOccupation before entering training school\nstudent\n8.\nFrom what hospital training school did you receive your diploma ?\nCity and State W orcester mass.\nCity Hospital\nDate of graduation\nGive name at time of graduation Deau m Durling\nmay 2, 1922\na\n9. Character hospital: General ? yes\nof\nSpecial ?\nPrivate ?\n10.\nDid your training include obstetrics yes Care of men ? up Children ? yes Contagious diseases? yes\n<\n11. Daily average number of patients in Hospital during trainingé 255:5-286 293.12 Length of course 3 years\nus\nt\n12. Name and address of superintendent of nurses under whom you received training. mins gene\nC\nV.B Yan Pelt,\n11\n13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\nBelmont Hospital, Workster man 2 months\n14.\nmass. state nurses asso\nOf what nursing organizations are you a member ? Woulster City Hospital alumnae\n15. Which, if any, is affiliated with the American Nurses' Association ? mass. State nurses ass.\n16.\nGive name and address of secretary of at least one of these organizations mrs Lrank Wessel\n3/5 Pleasant street Worcester mass.\n17. Are you a registered nurse yes in what State ? mass Date of registration Number 11651\n18. Type of work and length of service since graduation:\nInstitutional supervisor for eeven months.\nPrivate duty for two years\nPublic Health work for overear\n(Present position)\nPublic Health-\n19.\nWill you be willing to accept active service if the United States becomes involved in war? yes\n20. (a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing, Instructor,\nHome Hygiene and Care of Sick, Army, Navy U. S. Public Health Service, U. S. Veterans Bureau.\n(b)\nDate\nupon\nwhich you will be available where called\n21. Are you willing to take the oath of allegiance ? yes\n22. Name and permanent address of near relative\n58 Baneroft Park, Hopedale mass- Father\n(give relationship) Mrs. James H. Durling\nDate\nNOTE Nurses who have had training or experience in Public Health Nursing will, in addition to the above, out questions\nApril 3,1926 Signature of nurse Grace m Durling fill\n23 and 24 on reverse side of this blank.\nTo The Committee:\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.\n703. Application forms after approval and endorsement by Local committee, with Forms 1244, 1189, 1193 should\nbe forwarded to the Director of the Nursing Service in your Division Office.\nHEYTIH\na"
}