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Form 1082
Rev. 2-12-24
you
AMERICAN RED CROSS
HOME HYGIENE AND CARE OF THE SICK
APPLICATION FOR INSTRUCTORS
Please fill out this form
and RETURN TO
Director of Instruction in Home Hygiene and Care of the Sick,
New England
Division
73 Newbury Street
Boston, Massachusetts
Name in full Stafford, Ada H.
Badge No.
29467
(Surname first)
Address
62 Jackson Street
Providence, Rhode Island
(No. & street)
(City)
(State)
Telephone number Ga. 1614
Religion
Unitarian
Date of birth Aug. 19, 1876
Are you married, single or widow?
Single
State condition of health
Good
How many years have you attended High School? 4 yrs. Private School?
Normal School?
College? 1 year
(State degrees held)
Also check (v) those from which diploma was received.
What languages other than English do you speak? None
(Underline those which you speak fluently)
Name of Training School Conn. Training School for Nurses
Location
New Haven, Conn.
Date of graduation
May 1909
Registered
(State)
Special course in teaching
(Name and location of school)
Length of course
Do you hold State teacher's certificate?
State experience in teaching:
Public schools
Private schools
Hospital schools of nursing
Red Cross Home Hygiene and Care of the Sick
Other teaching experience
Give names and addresses of two former employers (preferably those familiar with
your teaching ability)
Miss Emma A. Stowe, Worcester, Mass.
Lincoln Neighborhood House, Boston, Mass. Samaritan Hospital, Troy, N.Y.
Present position Social Worker R.I. Homeopathic Hospital
When would you be available? Anytime
Signa ture Ada H. Stafford
Date
Oct. 11, 1924
NOV 2.4 1924
17927
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"ocrText": "+\nForm 1082\nRev. 2-12-24\nyou\nAMERICAN RED CROSS\nHOME HYGIENE AND CARE OF THE SICK\nAPPLICATION FOR INSTRUCTORS\nPlease fill out this form\nand RETURN TO\nDirector of Instruction in Home Hygiene and Care of the Sick,\nNew England\nDivision\n73 Newbury Street\nBoston, Massachusetts\nName in full Stafford, Ada H.\nBadge No.\n29467\n(Surname first)\nAddress\n62 Jackson Street\nProvidence, Rhode Island\n(No. & street)\n(City)\n(State)\nTelephone number Ga. 1614\nReligion\nUnitarian\nDate of birth Aug. 19, 1876\nAre you married, single or widow?\nSingle\nState condition of health\nGood\nHow many years have you attended High School? 4 yrs. Private School?\nNormal School?\nCollege? 1 year\n(State degrees held)\nAlso check (v) those from which diploma was received.\nWhat languages other than English do you speak? None\n(Underline those which you speak fluently)\nName of Training School Conn. Training School for Nurses\nLocation\nNew Haven, Conn.\nDate of graduation\nMay 1909\nRegistered\n(State)\nSpecial course in teaching\n(Name and location of school)\nLength of course\nDo you hold State teacher's certificate?\nState experience in teaching:\nPublic schools\nPrivate schools\nHospital schools of nursing\nRed Cross Home Hygiene and Care of the Sick\nOther teaching experience\nGive names and addresses of two former employers (preferably those familiar with\nyour teaching ability)\nMiss Emma A. Stowe, Worcester, Mass.\nLincoln Neighborhood House, Boston, Mass. Samaritan Hospital, Troy, N.Y.\nPresent position Social Worker R.I. Homeopathic Hospital\nWhen would you be available? Anytime\nSigna ture Ada H. Stafford\nDate\nOct. 11, 1924\nNOV 2.4 1924\n17927"
}