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the address of the Secretary.
Name in full
MARGARET A. STACK.
QUESTIONNAIRES Designitary
If married, give husband's name
Permanent address 49 9STATE STREE NEW HAVEN
CONN
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for next year AVE
(STREET, ETC.)
Telephone No.
NEW HAVEN
CONN
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
MOTHER. MRS MARY STACK, 49STATE St WINDSOR VERMONT
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? NO
Have you ever been? YES
Indicate present physical condition EXCELLENT.
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? YES
Badge No. 28379
Current date FEB 4th 1936.
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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- Source index
- 0
- Type
- photo
- Media ID
- c5ec7075b3861abc
- Size
- unknown
Document data
- ID
- 2662297
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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Page context
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"ocrText": "a\nthe address of the Secretary.\nName in full\nMARGARET A. STACK.\nQUESTIONNAIRES Designitary\nIf married, give husband's name\nPermanent address 49 9STATE STREE NEW HAVEN\nCONN\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for next year AVE\n(STREET, ETC.)\nTelephone No.\nNEW HAVEN\nCONN\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nMOTHER. MRS MARY STACK, 49STATE St WINDSOR VERMONT\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? NO\nHave you ever been? YES\nIndicate present physical condition EXCELLENT.\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? YES\nBadge No. 28379\nCurrent date FEB 4th 1936.\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}