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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
QUESTIONNAIRES DESTROYED
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
D. M. JOHNSTON
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
BUTLER HOSPITAL
:
PROV., RJ u
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full
Florence Elizabeth Little
If married, give husband's name
None
Permanent address 261 County Road, Barrington
Bristol
Rhode Island
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year 261 County Rd., Barrington, R.I.
(STREET, ETC.)
Warren 414
Telephone No.
Barrington
Bristol
Rhode Island
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Mrs. .B.Little (Mother) 36 Burlington St., Providence, R.I.
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service
-
Public Health - Institutional - Private Duty - Industrial Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? Yes
Have you ever been?
Yes Would you like to teach Red Cross classes?
No
Indicate present physical condition
Good
Yes
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 40,289
Current date March 3, 1939
NOTE. If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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"ocrText": "+\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nQUESTIONNAIRES DESTROYED\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nD. M. JOHNSTON\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nBUTLER HOSPITAL\n:\nPROV., RJ u\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full\nFlorence Elizabeth Little\nIf married, give husband's name\nNone\nPermanent address 261 County Road, Barrington\nBristol\nRhode Island\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year 261 County Rd., Barrington, R.I.\n(STREET, ETC.)\nWarren 414\nTelephone No.\nBarrington\nBristol\nRhode Island\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nMrs. .B.Little (Mother) 36 Burlington St., Providence, R.I.\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service\n-\nPublic Health - Institutional - Private Duty - Industrial Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? Yes\nHave you ever been?\nYes Would you like to teach Red Cross classes?\nNo\nIndicate present physical condition\nGood\nYes\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 40,289\nCurrent date March 3, 1939\nNOTE. If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}