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For Office Use Only
FORM 1219
1111
c
REV. AUG. 1941
o
Date Auth.
AMERICAN RED CROSS
P
21) TateneD
Type of Auth
Y
a
Chapter
APPLICATION FORM
State
PUBLIC HEALTH NURSE
and
Confidential
RED CROSS HOME NURSING INSTRUCTOR
Please return
Date 12/8/41
I. PERSONAL
Badge (No 38755
Miss Edith Loretta Olson
(H.D.
Name in full
(MISS OR MRS)
CIF MARRIED. GIVE MAIDEN NAME)
Not enrolled
1502 15th Avenue, Monroe, Wisconsin
Tel. No 671
Present address
(STREET)
(CITY)
(STATE)
Same
Tel. No.
Permanent address
(STREET)
00.008
(CITY)
(STATE)
Date of birth 4/27/98
Marital status Single smoH Dea
(SINGLE, MARRIED, WIDOWED, DIVORCED)
Race White
Citizenship American born
II. EDUCATION
1. Prior to entering school of nursing
Jardw of
Diploma
Name
City and State Dates or Degree
Major
Cokato
Minnespta
Graduated 1916
High School
Normal School
or University
Other
2. School of nursing from which you graduated
Name
Swedish Hospital School of Nursing
Location
Minneapolis, Minn.
Date of graduation 1920
Length of course. 3 yrs.
(CITY AND STATE)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
4. Academic study since graduation from school of nursing
College or University or
Diploma
postgraduate course
City and State No .Months or Degree
Major
3
PHN
Univ. of Minnesota
about 150 credits of the 180 needed for a BS degree
of
What courses in principles of teaching have you had? 1 of normal training in
9
the 4th yr. of high school
Have you had a course in practice teaching?
5
Do you hold a state teacher's certificate? no
Where
Do you speak a foreign language? Swedish
(Over)
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"ocrText": "For Office Use Only\nFORM 1219\n1111\nc\nREV. AUG. 1941\no\nDate Auth.\nAMERICAN RED CROSS\nP\n21) TateneD\nType of Auth\nY\na\nChapter\nAPPLICATION FORM\nState\nPUBLIC HEALTH NURSE\nand\nConfidential\nRED CROSS HOME NURSING INSTRUCTOR\nPlease return\nDate 12/8/41\nI. PERSONAL\nBadge (No 38755\nMiss Edith Loretta Olson\n(H.D.\nName in full\n(MISS OR MRS)\nCIF MARRIED. GIVE MAIDEN NAME)\nNot enrolled\n1502 15th Avenue, Monroe, Wisconsin\nTel. No 671\nPresent address\n(STREET)\n(CITY)\n(STATE)\nSame\nTel. No.\nPermanent address\n(STREET)\n00.008\n(CITY)\n(STATE)\nDate of birth 4/27/98\nMarital status Single smoH Dea\n(SINGLE, MARRIED, WIDOWED, DIVORCED)\nRace White\nCitizenship American born\nII. EDUCATION\n1. Prior to entering school of nursing\nJardw of\nDiploma\nName\nCity and State Dates or Degree\nMajor\nCokato\nMinnespta\nGraduated 1916\nHigh School\nNormal School\nor University\nOther\n2. School of nursing from which you graduated\nName\nSwedish Hospital School of Nursing\nLocation\nMinneapolis, Minn.\nDate of graduation 1920\nLength of course. 3 yrs.\n(CITY AND STATE)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\npostgraduate course\nCity and State No .Months or Degree\nMajor\n3\nPHN\nUniv. of Minnesota\nabout 150 credits of the 180 needed for a BS degree\nof\nWhat courses in principles of teaching have you had? 1 of normal training in\n9\nthe 4th yr. of high school\nHave you had a course in practice teaching?\n5\nDo you hold a state teacher's certificate? no\nWhere\nDo you speak a foreign language? Swedish\n(Over)"
}