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FORM 1219
III
REV. AUG. 1941
Dat Auth.
AMERICAN RED CROSS
11)
HONV88
renso
Type of Auth
Chapter
APPLICATION FORM
SSOUO 038 NVO183WV
L
State
SERVICE IN HAWAII
7 INVT
HEALTH KNURSE
I
u
Confidential
and
REDOOROSSOHOME NURSING INSTRUCTOR
:
Please return
I. PERSONAL
Date January (2, 1942
full miss Lucile Shields
Badge (No. 54490
Name in
(H.D
(MISS OR MRS)
OF MARRIED. GIVE MAIDEN NAME)
Not enrolled
Present (Day) address Richland Hospital Richland Center Wree No
456
3
(STREET)
(CITY)
(STATE)
Permanent (night) address 672 n. Park St. Richland Center,1 Wis Tel. No
(STREET)
(CITY)
(STATE)
Date of birth July 7, 1901
Marital status
Single DATERCOL
(BINGLE, MARRIED WIDOWED, DIVORCED)
Race white
Citizenship american ( Usse a
ASST. TO MGR.
II. EDUCATION
VI
LEEPER
MONTGOMERY
PETER. ON
1. Prior to entering school of nursing
Diploma
WEBER
Name
City and State
Dates
or Degree DISASTER Major
naed
FA, ws, AP
HOME SERV
High School gays mills
Normal School
gays mill * Wis 1970 plephon IUNION T
or University fa Crosse LaCrosse Was
NURSING
1924/1year
Other
TERSONNE
PUBLIC IVE
lanua
2. School of nursing from which you graduated
ROLL CALI
MIL. & NAV. WELF.
Name
st. Marin Jeanning School for nurses.
you.
Location Who Date of graduation 1929 Length of course. 3 years
(CITY AND STATE)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
milwauber Children's Hospital Melwankee, Wis Pediatrics
4 months
4. Academic study since graduation from school of nursing
College or University or
Diploma
5
postgraduate course
City and State
No Months
or Degree
Major
Chicago Lying In
Chicago Kee
4.
Certificate
Q.B
and
What courses in principles of teaching, have you had? Pural school Work
summer school, Crawford Co normal - Platterrille Teaching College
wis
Have you practice teaching? no- Taught 4 years in Runal schools
had a course in
Do you hold a state teacher's certificate? not at present Where
Do you speak a foreign language?
no
(Over)
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"ocrText": "S\nM\n5\nad\na\nFor Office Use Only\nFORM 1219\nIII\nREV. AUG. 1941\nDat Auth.\nAMERICAN RED CROSS\n11)\nHONV88\nrenso\nType of Auth\nChapter\nAPPLICATION FORM\nSSOUO 038 NVO183WV\nL\nState\nSERVICE IN HAWAII\n7 INVT\nHEALTH KNURSE\nI\nu\nConfidential\nand\nREDOOROSSOHOME NURSING INSTRUCTOR\n:\nPlease return\nI. PERSONAL\nDate January (2, 1942\nfull miss Lucile Shields\nBadge (No. 54490\nName in\n(H.D\n(MISS OR MRS)\nOF MARRIED. GIVE MAIDEN NAME)\nNot enrolled\nPresent (Day) address Richland Hospital Richland Center Wree No\n456\n3\n(STREET)\n(CITY)\n(STATE)\nPermanent (night) address 672 n. Park St. Richland Center,1 Wis Tel. No\n(STREET)\n(CITY)\n(STATE)\nDate of birth July 7, 1901\nMarital status\nSingle DATERCOL\n(BINGLE, MARRIED WIDOWED, DIVORCED)\nRace white\nCitizenship american ( Usse a\nASST. TO MGR.\nII. EDUCATION\nVI\nLEEPER\nMONTGOMERY\nPETER. ON\n1. Prior to entering school of nursing\nDiploma\nWEBER\nName\nCity and State\nDates\nor Degree DISASTER Major\nnaed\nFA, ws, AP\nHOME SERV\nHigh School gays mills\nNormal School\ngays mill * Wis 1970 plephon IUNION T\nor University fa Crosse LaCrosse Was\nNURSING\n1924/1year\nOther\nTERSONNE\nPUBLIC IVE\nlanua\n2. School of nursing from which you graduated\nROLL CALI\nMIL. & NAV. WELF.\nName\nst. Marin Jeanning School for nurses.\nyou.\nLocation Who Date of graduation 1929 Length of course. 3 years\n(CITY AND STATE)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\nmilwauber Children's Hospital Melwankee, Wis Pediatrics\n4 months\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\n5\npostgraduate course\nCity and State\nNo Months\nor Degree\nMajor\nChicago Lying In\nChicago Kee\n4.\nCertificate\nQ.B\nand\nWhat courses in principles of teaching, have you had? Pural school Work\nsummer school, Crawford Co normal - Platterrille Teaching College\nwis\nHave you practice teaching? no- Taught 4 years in Runal schools\nhad a course in\nDo you hold a state teacher's certificate? not at present Where\nDo you speak a foreign language?\nno\n(Over)"
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