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M
FORM 1037
REV. FEB. 1941
AMERICAN RED CROSS NURSING SERVICE
APPLICATION FOR ENROLLMENT
mm
(To be filled out in applicant's handwriting and each question answered fully)
R
1. Name of applicant in full
Reba Elizabeth memma
If married, give maiden name
2. Permanent
address 1474 neil ave Columbus
Frankline
Ohio
1
(Street)
(City)
(County)
(State)
3. Probable address for one year 2136 fulton St Toledo
Lucas
this
(Street)
(City)
(County)
(State)
4. Name and permanent address of nearest relative or friend residing in the United States:
Frank B. mumma. 1+74 nicl are Columbes lice father
E
(Name)
(Address)
(Relationship)
8. What languages other than English do you
=
5. Race
6. Present Marital Status
7. Citizenship
speak?
2
White
X. Single
X1 Native born
None
German
4 Negro
Married
Naturalized
Spanish
Scandinavian
a
Other
Widowed
Non citizen
French
Polish
Divorced
Italian
Other
Catholic Sister
9. Date of birth Junuare, 1916
Place of birth Payne, thio
Is Father a citizen of the
Yes
United States?
No
10. General education (prior to entering nursing):
Did you graduate from high school
Yes
If no, how many years of high school do you lack?
No
What college or university education did you have prior to entering nursing?
o None or less
1 year;
IX12 2 years;
3 years;
Bachelors
Masters
PH.D.
than 1 year;
Degree;
Degree;
11. Nursing Education:
a. School of nursing from which
graduated Ohio State University. School (Name) of Nursing (City) Columbus Ohio (State)
Date of graduation Dec. 19
1941
Length of course: X.2 5 years;
3 years;
(Specify Other)
b. Undergraduate affiliations:
Clinical
Hospital or Organization
City and State
specialty
No. months
(1) Instructive district nurse asin
Columbus, this
Public Health
3. mo
(2)
(3)
c. Postgraduate clinical courses (Do not include academic work or employment)
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
ossom)
(3)
I
d. Academic study since graduation from School of Nursing:
D°IA
College or University
City and State
Number of full time
Number of
academic years
points
D
13
(1)
(2)
(3)
e. Check all degrees obtained
X. Bachelors
Masters
PH. D.
Certificate in Public Health
subsequent to entering training:
Degree;
Degree;
Nursing
f. In which major field was your academic study?
Institutional
Public Health
a
5
Non nursing (specify)
Education
Other (specify)
(Over)
18
Page data
- Page
- 79
- Source index
- 0
- Type
- photo
- Media ID
- 502de6e79b476813
- Size
- unknown
Document data
- ID
- 2662008
- Core
- doc
- Type
- document
DTO data
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"ocrText": "M\nFORM 1037\nREV. FEB. 1941\nAMERICAN RED CROSS NURSING SERVICE\nAPPLICATION FOR ENROLLMENT\nmm\n(To be filled out in applicant's handwriting and each question answered fully)\nR\n1. Name of applicant in full\nReba Elizabeth memma\nIf married, give maiden name\n2. Permanent\naddress 1474 neil ave Columbus\nFrankline\nOhio\n1\n(Street)\n(City)\n(County)\n(State)\n3. Probable address for one year 2136 fulton St Toledo\nLucas\nthis\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nFrank B. mumma. 1+74 nicl are Columbes lice father\nE\n(Name)\n(Address)\n(Relationship)\n8. What languages other than English do you\n=\n5. Race\n6. Present Marital Status\n7. Citizenship\nspeak?\n2\nWhite\nX. Single\nX1 Native born\nNone\nGerman\n4 Negro\nMarried\nNaturalized\nSpanish\nScandinavian\na\nOther\nWidowed\nNon citizen\nFrench\nPolish\nDivorced\nItalian\nOther\nCatholic Sister\n9. Date of birth Junuare, 1916\nPlace of birth Payne, thio\nIs Father a citizen of the\nYes\nUnited States?\nNo\n10. General education (prior to entering nursing):\nDid you graduate from high school\nYes\nIf no, how many years of high school do you lack?\nNo\nWhat college or university education did you have prior to entering nursing?\no None or less\n1 year;\nIX12 2 years;\n3 years;\nBachelors\nMasters\nPH.D.\nthan 1 year;\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\ngraduated Ohio State University. School (Name) of Nursing (City) Columbus Ohio (State)\nDate of graduation Dec. 19\n1941\nLength of course: X.2 5 years;\n3 years;\n(Specify Other)\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1) Instructive district nurse asin\nColumbus, this\nPublic Health\n3. mo\n(2)\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\nossom)\n(3)\nI\nd. Academic study since graduation from School of Nursing:\nD°IA\nCollege or University\nCity and State\nNumber of full time\nNumber of\nacademic years\npoints\nD\n13\n(1)\n(2)\n(3)\ne. Check all degrees obtained\nX. Bachelors\nMasters\nPH. D.\nCertificate in Public Health\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\nInstitutional\nPublic Health\na\n5\nNon nursing (specify)\nEducation\nOther (specify)\n(Over)\n18"
}