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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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Document data
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- Core
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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."
}