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FORM 1219
REV. AUG. 1941
Date Auth.
AMERICAN RED CROSS
Type of Auth
Chapter
APPLICATION FORM
Mra.
M.
State
TO
PUBLIC HEALTH NURSE
Confidential
and
RED CROSS HOME NURSING INSTRUCTOR
Please return
Date
Jon 26-1942
I. PERSONAL
Name in eurshus Liema Pauline Refort Powell
Badge (No.
(H.D. 4194
=
(MISS OR MRS)
(IF MARRIED. GIVE MAIDEN NAME)
Present address 177. Bannach Baise Idaho Tel. No. 752-R
Not enrolled
s
in
(STREET)
(CITY)
(STATE)
e
Permanent address RT.#2 # Caldevell Idaho
Tel. No.
(STREET)
(CITY)
(STATE)
Date of birth march 25-1919
Marital status
married
K
(SINGLE, MARRIED, WIDOWED, DIVORCED)
Race white
Citizenship
am
e
1
a
II. EDUCATION
to
&
VI
0
c
1. Prior to entering school of nursing
PeredW
Diploma
+
Name
City and State
Dates
or Degree
Major
High School hotus H. Sel hotus Idaho
1933-37
Normal School
P
K
or University
Other
2. School of nursing from which you graduated
Name IT. Subis Hosp and Jr. school
Location Baise Adaho Date of graduation 1941
(CITY AND STATE)
Length of course year
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
4. Academic study since graduation from school of nursing
appearance
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?
no
Do you hold a state teacher's certificate?
"
Where
Do you speak a foreign language?
"
(Over)
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- Source index
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Document data
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- Core
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"ocrText": "x\nFor Office Use Only\nFORM 1219\nREV. AUG. 1941\nDate Auth.\nAMERICAN RED CROSS\nType of Auth\nChapter\nAPPLICATION FORM\nMra.\nM.\nState\nTO\nPUBLIC HEALTH NURSE\nConfidential\nand\nRED CROSS HOME NURSING INSTRUCTOR\nPlease return\nDate\nJon 26-1942\nI. PERSONAL\nName in eurshus Liema Pauline Refort Powell\nBadge (No.\n(H.D. 4194\n=\n(MISS OR MRS)\n(IF MARRIED. GIVE MAIDEN NAME)\nPresent address 177. Bannach Baise Idaho Tel. No. 752-R\nNot enrolled\ns\nin\n(STREET)\n(CITY)\n(STATE)\ne\nPermanent address RT.#2 # Caldevell Idaho\nTel. No.\n(STREET)\n(CITY)\n(STATE)\nDate of birth march 25-1919\nMarital status\nmarried\nK\n(SINGLE, MARRIED, WIDOWED, DIVORCED)\nRace white\nCitizenship\nam\ne\n1\na\nII. EDUCATION\nto\n&\nVI\n0\nc\n1. Prior to entering school of nursing\nPeredW\nDiploma\n+\nName\nCity and State\nDates\nor Degree\nMajor\nHigh School hotus H. Sel hotus Idaho\n1933-37\nNormal School\nP\nK\nor University\nOther\n2. School of nursing from which you graduated\nName IT. Subis Hosp and Jr. school\nLocation Baise Adaho Date of graduation 1941\n(CITY AND STATE)\nLength of course year\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\n4. Academic study since graduation from school of nursing\nappearance\nCollege or University or\nDiploma\npostgraduate course\nCity and State No Months\nor Degree\nMajor\nI\nWhat courses in principles of teaching have you had?\nHave you had a course in practice teaching?\nno\nDo you hold a state teacher's certificate?\n\"\nWhere\nDo you speak a foreign language?\n\"\n(Over)"
}