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N FORM NO. 1 THE GROSS WASHINGTON BUREAU OF NURSING SERVICE APPLICATION FOR ENROLLMENT (To be filled out entirely in applicant's handwriting) I. Name of applicant in full Frances Beslup anclus 2. Address in full Va West 9125 st. h.y. e 3. Date of birth sept 15-03 1893 Place of birth Bristol R. D 4. Are you married, single or a widow? single Are you a citizen of the United States? yes 5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no, 6. Name educational institutions attended before entering training school, stating number of years at each and from which you were graduated & his Backes Provate school Bristol R9 3 yrs Bristol 2 High Sol Bristol Grammer schools 4yrs Luid at home yes 7. Occupation before entering training school 8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation ST many free Hospital for Children 405 W 34thSt. h.y.e. april 2nd 1915- If training as a nurse was received in more than one hospital, give name, location and time spent in each Bluos Rossevels 9. your Hospital 59th St. 3 mos. Sying In Hospital 2 Auth IO. Character of hospital: General? Special? Private? II. Did your training include the care of men? yes Contagious diseases? no Obstetrics? yes 12. Daily average number of patients in hospital during training i25 Length of course 21 2 yrs 13. Name and address of superintendent of training school under whom you received training Sister Esther Clements 405 W 34thst hye. 14. Of what nursing organizations are you a member? ST mary alimas ass. Public Health huring as 15. Which, if any, is affiliated with the American Nurses Association? Rublic Health hurring as 16. Give name and address of secretary of at least one of these organization this marron Smith St many Alian 224 Inword Ave. upper montclain. h.g 17 Are you a registered nurse? yes In what state? my Date of registration 1917 18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present employment Willies Dispensary 9th Aree t 38 SST. 6hos highest Superior .st many free Hospital for Children 405W34th st hys Printe nursing 4 mos Henry It Lettlement Since 19.8 201 1916 up to present hum 19. Should our country be involved in war, would you be available for active service? yes 20. Would you be willing to take the oath of allegiance? yes 21. What languages other than English do you speak? now 22. Name and permanent address of nearest relative his an ander 9 w912 IT h.y.e Date may 1917 Signature Frances Cuclus This blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. 10-11 to After the approval and endorsement by local Committee to be forwarded with "credentials" (Forms Nos. 3 and 4) together with Forms Chairman, National Committee on Red Cross Nursing Service, Washington, D. c. REQ. 17-109-FRB.-5000.

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    "ocrText": "N\nFORM NO. 1\nTHE GROSS\nWASHINGTON\nBUREAU OF NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nI. Name of applicant in full\nFrances Beslup anclus\n2.\nAddress in full Va West 9125 st. h.y. e\n3.\nDate of birth\nsept 15-03 1893\nPlace of birth\nBristol R. D\n4. Are you married, single or a widow?\nsingle\nAre you a citizen of the United States? yes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno,\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nwere graduated\n&\nhis Backes Provate school Bristol R9 3 yrs Bristol 2 High Sol\nBristol Grammer schools 4yrs\nLuid at home\nyes\n7.\nOccupation before entering training school\n8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation\nST many free Hospital for Children\n405 W 34thSt. h.y.e. april 2nd 1915-\nIf training as a nurse was received in more than one hospital, give name, location and time spent in each\nBluos\nRossevels 9. your Hospital 59th St. 3 mos. Sying In Hospital 2 Auth\nIO. Character of hospital: General?\nSpecial?\nPrivate?\nII. Did your training include the care of men? yes Contagious diseases? no Obstetrics?\nyes\n12. Daily average number of patients in hospital during training\ni25\nLength\nof\ncourse\n21 2 yrs\n13. Name and address of superintendent of training school under whom you received training\nSister\nEsther Clements 405 W 34thst hye.\n14. Of what nursing organizations are you\na member? ST mary alimas ass.\nPublic Health huring\nas\n15. Which, if any, is affiliated with the American Nurses Association?\nRublic Health hurring as\n16. Give name and address of secretary of at least one of these organization this marron Smith\nSt many Alian\n224 Inword Ave. upper montclain. h.g\n17 Are you a registered nurse?\nyes\nIn\nwhat\nstate?\nmy\nDate of registration\n1917\n18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present\nemployment Willies Dispensary 9th Aree t 38 SST. 6hos\nhighest Superior .st many free Hospital for\nChildren 405W34th st hys Printe\nnursing 4 mos Henry It Lettlement\nSince 19.8 201 1916 up to present hum\n19. Should our country be involved in war, would you be available for active service?\nyes\n20. Would you be willing to take the oath of allegiance?\nyes\n21. What languages other than English do you speak?\nnow\n22. Name and permanent address of nearest relative\nhis an ander\n9 w912 IT h.y.e\nDate\nmay\n1917\nSignature Frances Cuclus\nThis blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. 10-11 to After the\napproval and endorsement by local Committee to be forwarded with \"credentials\" (Forms Nos. 3 and 4) together with Forms\nChairman, National Committee on Red Cross Nursing Service, Washington, D. c.\nREQ. 17-109-FRB.-5000."
}