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FEB 20 1940
FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full
Stanns
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address 1900S. (STREET) Onling tou (CITY) Ay Card (COUNTY) wring tou (STATE) Virguia
Probable address
for the next year
James ahon
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number Johnson (EXCHANGE) 2128W (NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an emergency:
617 (STREET) (CITY) (RELATIONSHIP)
(NAME) Shoursou Uu
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
Public Health
Private duty
Other (write in)
anny retired
Government Service: Army.
U.S. P.H. Service
Veterans Administration
Navy
U.S. Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
(Granted of course that you could be released from present employment)
Present physical condition
Would you be interested in teaching classes in Home Hygiene Care
good and of the Sick? no
Are you a member of the American Nurses' Association?
yes
If not, why have you allowed your membership to lapse?
Badge No. 8059
Current date Mac +1940
Name of Committee
NATIONAL HEADQUARTERS
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enroilment will be removed from our active files.
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"ocrText": "FEB 20 1940\nFORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full\nStanns\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address 1900S. (STREET) Onling tou (CITY) Ay Card (COUNTY) wring tou (STATE) Virguia\nProbable address\nfor the next year\nJames ahon\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Johnson (EXCHANGE) 2128W (NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan emergency:\n617 (STREET) (CITY) (RELATIONSHIP)\n(NAME) Shoursou Uu\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nanny retired\nGovernment Service: Army.\nU.S. P.H. Service\nVeterans Administration\nNavy\nU.S. Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\n(Granted of course that you could be released from present employment)\nPresent physical condition\nWould you be interested in teaching classes in Home Hygiene Care\ngood and of the Sick? no\nAre you a member of the American Nurses' Association?\nyes\nIf not, why have you allowed your membership to lapse?\nBadge No. 8059\nCurrent date Mac +1940\nName of Committee\nNATIONAL HEADQUARTERS\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enroilment will be removed from our active files."
}