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Mut
,
1
st
5
FORM 1037
1.
X
REV. FEB. 1942
AMERICAN RED CROSS
4-29-
ct
APPLICATION FOR ENROLLMENT IN NURSING SERVICE
(To be filled out in applicant's handwriting and each question answered fully)
the
1. Name of applicant in full
If married, give maiden name
Bertra hene murphy
10/2
2. Permanent address 2101 new Hampshire (Street) are.,n.w. (City) Washington, (County) D.C.
(State)
3. Probable address for year (Same)
one
(Street)
(City)
(County)
(State)
4. Name and permanent address of nearest relative or friend residing in the United States:
mrs. B. 7. murphy Name) Laurel, maryland (Address) % John n. Robey mother (Relationship)
5. Race
6. Present Marital Status
7. Citizenship
8. What languages other than English do you
speak?
2 White
1 Single
1 Native born
o None
4 German
4 Negro
2 Married
2 Naturalized
1 Spanish
5 Scandinavian
6 Other
3 Widowed
3 Non citizen
2 French
6 Polish
Nationality
4 Divorced
3 Italian
7 Other
5 Catholic Sister
9. Date of birth January 23, (Day) 1897
Place of birth fulton, md.
Is father a citizen of the
(Year)
United States ?
Yes
No.
10. Birthplace General education of father (prior maryland to entering nursing) : mother Drillery maryland Business College in longer operating.
Did you graduate from high school ? no If not, how many years of high school did you have? none
Have you graduated from high school since entering nursing
Yes
No.
What college or university education did you have prior to entering nursing?
0 None or less
1 1 year;
2 2 years;
3 3 years;
4 Bachelor's
5 Master's
6 Ph.D.
than 1 year
Degree;
Degree;
11. Nursing Education:
a. School of nursing from which
graduated maryland (Name) General Hospital
Battemore. (City) merifand (State)
Date of completion of course may 11
1926 Length of course:
5 years;
3 years;
b. Undergraduate affiliations:
(Specify other)
Clinical
Hospital or Organization
City and State
specialty
No. months
(2) (1) Enoch sheppard Prat Hospital Townsend md
2mo
(3)
c. Postgraduate clinical courses (Do not include academic work or employment.)
Clinical
Inclusive
Hospital or Organization
City and State
specialty
dates
(1)
I
(2)
(3)
I
d. Academic study since graduation from School of Nursing:
Number of full-time
Number of
College or University
City and State
academic years
points
(1)
(2)
(3)
e. Check all degrees obtained
4 Bachelor's
5 Master's
6 Ph.D.
7 Certificate in Public Health
subsequent to entering training
Degree;
Degree;
Nursing
f. In which major field was your academic study?
1 Institutional
2 Public Health
5
Non nursing (specify)
Other (specify)
(OVER)
Page data
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- Type
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- Media ID
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Document data
- ID
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- Core
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- Type
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DTO data
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"ocrText": "I\nMut\n,\n1\nst\n5\nFORM 1037\n1.\nX\nREV. FEB. 1942\nAMERICAN RED CROSS\n4-29-\nct\nAPPLICATION FOR ENROLLMENT IN NURSING SERVICE\n(To be filled out in applicant's handwriting and each question answered fully)\nthe\n1. Name of applicant in full\nIf married, give maiden name\nBertra hene murphy\n10/2\n2. Permanent address 2101 new Hampshire (Street) are.,n.w. (City) Washington, (County) D.C.\n(State)\n3. Probable address for year (Same)\none\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nmrs. B. 7. murphy Name) Laurel, maryland (Address) % John n. Robey mother (Relationship)\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nspeak?\n2 White\n1 Single\n1 Native born\no None\n4 German\n4 Negro\n2 Married\n2 Naturalized\n1 Spanish\n5 Scandinavian\n6 Other\n3 Widowed\n3 Non citizen\n2 French\n6 Polish\nNationality\n4 Divorced\n3 Italian\n7 Other\n5 Catholic Sister\n9. Date of birth January 23, (Day) 1897\nPlace of birth fulton, md.\nIs father a citizen of the\n(Year)\nUnited States ?\nYes\nNo.\n10. Birthplace General education of father (prior maryland to entering nursing) : mother Drillery maryland Business College in longer operating.\nDid you graduate from high school ? no If not, how many years of high school did you have? none\nHave you graduated from high school since entering nursing\nYes\nNo.\nWhat college or university education did you have prior to entering nursing?\n0 None or less\n1 1 year;\n2 2 years;\n3 3 years;\n4 Bachelor's\n5 Master's\n6 Ph.D.\nthan 1 year\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\ngraduated maryland (Name) General Hospital\nBattemore. (City) merifand (State)\nDate of completion of course may 11\n1926 Length of course:\n5 years;\n3 years;\nb. Undergraduate affiliations:\n(Specify other)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(2) (1) Enoch sheppard Prat Hospital Townsend md\n2mo\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment.)\nClinical\nInclusive\nHospital or Organization\nCity and State\nspecialty\ndates\n(1)\nI\n(2)\n(3)\nI\nd. Academic study since graduation from School of Nursing:\nNumber of full-time\nNumber of\nCollege or University\nCity and State\nacademic years\npoints\n(1)\n(2)\n(3)\ne. Check all degrees obtained\n4 Bachelor's\n5 Master's\n6 Ph.D.\n7 Certificate in Public Health\nsubsequent to entering training\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\n1 Institutional\n2 Public Health\n5\nNon nursing (specify)\nOther (specify)\n(OVER)"
}