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Form 1037
Rev. 12-1-26
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1. Name of applicant in full
2.
Address in full 1000 University S.E. Memmeapolis minister
Levice Pitry
3. Date of birth Jan 23 1902
Race
W
Place of birth this
Birthplace of father Ohio
Mother Ohio
Citizenship of father u.s.
4. Are you married, single or a widow? S
Are you a citizen of the United States? yes
5. How many years have you attended grammar school? 8 High school? 4 Normal school?
Private school?
College? 4 if tutored privately, name subjects covered and length of time
year pantgraduate M.A. degree Teacher's College Columber university
6.
What languages other than English do you speak?
Read French Spanish do not
(Underline those which you speak fluently.)
7. Occupation before entering training school
none
8. From what hospital training school did you receive your diploma? Johns Hapkins Hospital Self of nursing
City and State Baltimore maryland Date of graduation Feb 1927
Give name at time of graduation
Lucile Pitry
9.
Character of hospital: General?
Special?
Private?
10. Did your training include obstetrics? Care of men? yes Children? yes Contagious diseases? yes
11. Daily average number of patients in hospital during training 590 Length of course 3 yr
12. Name and address of superintendent of nurses under whom you received training Elsie Lawler
Hapkins Hospital, Ballinor masyland
13. If your training as a nurse was received in more than one hospital, give name, location and time spent
in each
14. Are you a member of your Alumnae Association?
yes
15. Are you affiliated with the American Nurses Association through membership in Alumnae, District
and State Associations?
yes
16. Give name and address of secretary of at least one of these organizations
maud Guest Sec. State League of - Oah Terrace minin
17. Are you a registered nurse? yes in what State? md Date of registrationJune 27 Number 4790
18. Type of work and length of service since graduation:
Head nurse - Johns Hapkins Hospital Baltime Jch1927-Jan 1928
aret Supermin
Juneffext 1928
Surpeal
yah Self of nursing
Supernin of Clusical " Instruction-mir " of mini Sch 1924
Jane-Sept 1929
(Present position)
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 for service checked
21. Are you willing to take the oath of allegiance?
yes
22. Give name and permanent address of nearest relative or friend, residing in the United States (state
relationship). D.A.Putry (father Felton, Delaware
Date Apr 5-1930 Signature of nurse Lucile Pitry
NOTE-Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill out questions 23 and 24 on reverse side of
this blank.
To The Local 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 endorsment by Local Committee, with Forms 1244, 1189, and 1193 should be forwarded to
National Headquarters or to the proper Branch Office.
HEVELH norance
(OVER)
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"ocrText": "Form 1037\nRev. 12-1-26\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1. Name of applicant in full\n2.\nAddress in full 1000 University S.E. Memmeapolis minister\nLevice Pitry\n3. Date of birth Jan 23 1902\nRace\nW\nPlace of birth this\nBirthplace of father Ohio\nMother Ohio\nCitizenship of father u.s.\n4. Are you married, single or a widow? S\nAre you a citizen of the United States? yes\n5. How many years have you attended grammar school? 8 High school? 4 Normal school?\nPrivate school?\nCollege? 4 if tutored privately, name subjects covered and length of time\nyear pantgraduate M.A. degree Teacher's College Columber university\n6.\nWhat languages other than English do you speak?\nRead French Spanish do not\n(Underline those which you speak fluently.)\n7. Occupation before entering training school\nnone\n8. From what hospital training school did you receive your diploma? Johns Hapkins Hospital Self of nursing\nCity and State Baltimore maryland Date of graduation Feb 1927\nGive name at time of graduation\nLucile Pitry\n9.\nCharacter of hospital: General?\nSpecial?\nPrivate?\n10. Did your training include obstetrics? Care of men? yes Children? yes Contagious diseases? yes\n11. Daily average number of patients in hospital during training 590 Length of course 3 yr\n12. Name and address of superintendent of nurses under whom you received training Elsie Lawler\nHapkins Hospital, Ballinor masyland\n13. If your training as a nurse was received in more than one hospital, give name, location and time spent\nin each\n14. Are you a member of your Alumnae Association?\nyes\n15. Are you affiliated with the American Nurses Association through membership in Alumnae, District\nand State Associations?\nyes\n16. Give name and address of secretary of at least one of these organizations\nmaud Guest Sec. State League of - Oah Terrace minin\n17. Are you a registered nurse? yes in what State? md Date of registrationJune 27 Number 4790\n18. Type of work and length of service since graduation:\nHead nurse - Johns Hapkins Hospital Baltime Jch1927-Jan 1928\naret Supermin\nJuneffext 1928\nSurpeal\nyah Self of nursing\nSupernin of Clusical \" Instruction-mir \" of mini Sch 1924\nJane-Sept 1929\n(Present position)\n19. Will 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) Date upon which you will be available for service checked\n21. Are you willing to take the oath of allegiance?\nyes\n22. Give name and permanent address of nearest relative or friend, residing in the United States (state\nrelationship). D.A.Putry (father Felton, Delaware\nDate Apr 5-1930 Signature of nurse Lucile Pitry\nNOTE-Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill out questions 23 and 24 on reverse side of\nthis blank.\nTo The Local Committee:\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C. 703.\nApplication forms after approval and endorsment by Local Committee, with Forms 1244, 1189, and 1193 should be forwarded to\nNational Headquarters or to the proper Branch Office.\nHEVELH norance\n(OVER)"
}