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Form 1037
11-11-21
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully)
1. Name of applicant in full
mary Taylor
2. Address in full
V
319 S. Shelby St.
cadillac mich
31 1/2
Date of birth
Sept 20, 1893
Race white Place of birth Lucas, mich.
Birthplace of father Illinois Mother Illinois
Citizenship of father american
4. Are you married, single or a widow? Single Are you a citizen of the United States? yes
5. How many years have you attended grammar school? 8
High school? 2
Normal school?
0
Private school?
0
College?
O If tutored privately, name subjects covered and length of time none
6. What languages other than English do you speak?
none
(Underline those which you speak fluently)
7. Occupation before entering training school Household duties at home
what
8. From what hospital training school did you receive your diploma?
mercy Hospital
City and State
Cadillae mich
Date of graduation Dec.13, 1920
Give name at time of graduation
mary taylor
9.
Character of hospital: General? general Special?
Private?
10. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? no
11. Daily average number of patients in hospital during training 20 to 30 Length of course 3yrs
12. Name and address of superintendent of training school under whom you received training
Sr. many monica, St. many's Hospital, grand Rapids mich.
13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each
3 mo. childrens free Hospital Detroit,mid. Rest of time in Caddla
14. Of what nursing organizations are you a member?
none at present.
15. Which, if any, is affiliated with the American Nurses' Association?
16. Give name and address of secretary of at least one of these organizations
17. Are you a registered nurse? yes In what State? mich Date of registration July30.19 Number 4485
18. Type of work and length of service since graduation:
Private duty nursing 2 yrs 8 mo.
(Present position)
wexford Co. nurse
19. Will you be willing to accept active service if the United States becomes involved in war?
yes
20.
(a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing, Instructor, Home
Hygiene and Care of Sick, Army, Navy, U. S. Public Health Service, U. S. Veterans Bureau.
(b) Date upon which you will be available
21. Are you willing to take the oath of allegiance?
yes
22. Name and address of relative
Lucas, much Father & mother
permanent near (give relationship) miamis Weller H. Taylor
Date may29,1424 Signature of many Taylor
nurse
NOTE - Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill
out questions 23 and 24 on reverse side of this blank.
To The Committee:
This blank is to be sent to applicant with circular letter Form 1199, together with Forms D. M. R. 2, 1193 and
A.
R. C. 703. Application forms after approval and endorsement by Local committee, with Forms 1244, 1189, 1193
should be forwarded to the director of the Nursing Service in your Division Office.
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"ocrText": "Form 1037\n11-11-21\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully)\n1. Name of applicant in full\nmary Taylor\n2. Address in full\nV\n319 S. Shelby St.\ncadillac mich\n31 1/2\nDate of birth\nSept 20, 1893\nRace white Place of birth Lucas, mich.\nBirthplace of father Illinois Mother Illinois\nCitizenship of father american\n4. Are you married, single or a widow? Single Are you a citizen of the United States? yes\n5. How many years have you attended grammar school? 8\nHigh school? 2\nNormal school?\n0\nPrivate school?\n0\nCollege?\nO If tutored privately, name subjects covered and length of time none\n6. What languages other than English do you speak?\nnone\n(Underline those which you speak fluently)\n7. Occupation before entering training school Household duties at home\nwhat\n8. From what hospital training school did you receive your diploma?\nmercy Hospital\nCity and State\nCadillae mich\nDate of graduation Dec.13, 1920\nGive name at time of graduation\nmary taylor\n9.\nCharacter of hospital: General? general Special?\nPrivate?\n10. Did your training include obstetrics? yes Care of men? yes Children? yes Contagious diseases? no\n11. Daily average number of patients in hospital during training 20 to 30 Length of course 3yrs\n12. Name and address of superintendent of training school under whom you received training\nSr. many monica, St. many's Hospital, grand Rapids mich.\n13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each\n3 mo. childrens free Hospital Detroit,mid. Rest of time in Caddla\n14. Of what nursing organizations are you a member?\nnone at present.\n15. Which, if any, is affiliated with the American Nurses' Association?\n16. Give name and address of secretary of at least one of these organizations\n17. Are you a registered nurse? yes In what State? mich Date of registration July30.19 Number 4485\n18. Type of work and length of service since graduation:\nPrivate duty nursing 2 yrs 8 mo.\n(Present position)\nwexford Co. nurse\n19. Will you be willing to accept active service if the United States becomes involved in war?\nyes\n20.\n(a) If interested in accepting service within the near future, indicate choice: R. C. P. H. Nursing, Instructor, Home\nHygiene and Care of Sick, Army, Navy, U. S. Public Health Service, U. S. Veterans Bureau.\n(b) Date upon which you will be available\n21. Are you willing to take the oath of allegiance?\nyes\n22. Name and address of relative\nLucas, much Father & mother\npermanent near (give relationship) miamis Weller H. Taylor\nDate may29,1424 Signature of many Taylor\nnurse\nNOTE - Nurses who have had training or experience in Public Health Nursing will, in addition to the above, fill\nout questions 23 and 24 on reverse side of this blank.\nTo The Committee:\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms D. M. R. 2, 1193 and\nA.\nR. C. 703. Application forms after approval and endorsement by Local committee, with Forms 1244, 1189, 1193\nshould be forwarded to the director of the Nursing Service in your Division Office."
}