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M
I
a
a
,
p
For Office Use Only
Howaii buit
, stor
5
Date Auth
FORM 1219
X
AMERICAN RED CROSS
REV. AUG 1941
Type of Auth.
Chapter
APPLICATION FORM
ct
State:
Confidential
PUBLIC HEALTH and NURSE 90 Hurring Service.
0
RED CROSS HOME NURSING INSTRUCTOR
of
Please return
I. PERSONAL
Date September 24,1942
Name in full (Miss) (MISS Butha OR MRS.) cl murphy
Badge (No
(H.D.
(IF MARRIED, GIVE MAIDEN NAME)
Not enrolled
Present address. 2101 new (STREET) Hempslever are (CITY) Washington, (STATE) Tel. No Dupont 7626
Permanent address 2101 (STREET) new Hampshire aren.w (CITY) Washington we (STATE)
Tel. No Desport 7626
H
Date of birth January 23, 1897
Marital status Single
Race white
SINGLE, MARRIED, WIDOWED. DIVORCED)
Citizenship nature born
e
II. EDUCATION
1 Prior to entering school of nursing
Diploma
Name
City and State
Dates
or Degree
Major
High School
Normal School
or Uniyersity
Other Business Course Drilley Business College no longes operating
2. School of nursing from which you graduated
Name manland General Hospital
Location Baltimore md
(CITY AND STATE) Date of graduationatney 11,1926 Length of course. 3 years
3. Undergraduate affiliations
Hospital or Organization
Length of
City and State
Type
time spent
4. Academic study since graduation from school of nursing
I
College or University or
Diploma
postgraduate course
City and State No. Months or Degree
Major
I
What courses in principles of teaching have you had?
Have you had a course in practice teaching?
10,
Do you hold a state teacher's certificate
Where
Do you speak a foreign language? no
g
(Over)
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