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FORM 1045
REV. 1-2-35
THE AMERICAN RED CROSS
with
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
7.8437
State and Local Committee
Red Cross Nursing Service
Providence. R. 1.
Dear Madam:
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:
Yours sincerely,
In order to render prompt service
MRS. PAUL APPLETON
Chairman on
35 Taber Ave.
in time of disaster, enrolled Red Cross
PROVIDENCE, Porto
Secretary.
Nurses should report at once to the
Secretary of the Local Committee under
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Florence Elizabeth Little
If married, give husband's name
-
Permanent address 36 St. Providence (CITY) (COUNTY) Pin
Burlington
R.9.
(STREET, ETC.)
(STATE)
Probable
address for the next year 26.1 County (STREET Road ETC.)
Telephone No. Waven 414
Barrington
Bustol
R.9.
(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)
mother mrs. H. B Little, 36 Burlington St, Pror R.D
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? no
Have you ever been? no
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No.
#2 card 40289 Current date Feb 17, 1937
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. 1-2-35\nTHE AMERICAN RED CROSS\nwith\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\n7.8437\nState and Local Committee\nRed Cross Nursing Service\nProvidence. R. 1.\nDear Madam:\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:\nYours sincerely,\nIn order to render prompt service\nMRS. PAUL APPLETON\nChairman on\n35 Taber Ave.\nin time of disaster, enrolled Red Cross\nPROVIDENCE, Porto\nSecretary.\nNurses should report at once to the\nSecretary of the Local Committee under\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nFlorence Elizabeth Little\nIf married, give husband's name\n-\nPermanent address 36 St. Providence (CITY) (COUNTY) Pin\nBurlington\nR.9.\n(STREET, ETC.)\n(STATE)\nProbable\naddress for the next year 26.1 County (STREET Road ETC.)\nTelephone No. Waven 414\nBarrington\nBustol\nR.9.\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)\nmother mrs. H. B Little, 36 Burlington St, Pror R.D\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\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? no\nHave you ever been? no\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No.\n#2 card 40289 Current date Feb 17, 1937\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."
}