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Wins,
Form 1082
Fór Office Use Only
Rev. Dec. 1941
AMERICAN RED CROSS
Date of Auth
Type of Auth
APPLICATION FOR AUTHORIZATION TO TEACH
Chapter
RED CROSS HOME NURSING
State
I. PERSONAL
Badge JNo 4397
Name in full MISS MARY M. A. welss
H.D.D.
(Miss or Mrs.)
(If married, give maiden name also)
Not enrolled
Present address 1849 ANTHONY AVE., New YORK, 57, New YORK
(street)
(city)
(state)
Date of birth JAN. 22 , 1887
Single
i
Marriod
Widowed
Divorced
Race White
Citizenship American
Present position STAFF NURSE COMMUNITY service society
(Title)
(Agency)
(City and State) N.Y,N.Y.
II. EDUCATION
1. Prior to entering school of nursing
Diploma
PSIs Name
City and State
Dates
or Degree
Major
High School aming H, S. myc x
12TE 51-
Normal School
-
-
-
-
or University
Other
PART OF GRADE SCHOOL
2. School of nursing
Nome N.Y. POST GRADUATE MEDICAL SCHOOL of HOSPITAL.
Location N.Y. N.Y.
Date of graduation 1912
Length of course 3 yrs.
(city and state)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
MANHATTAN Eye YEAR HOSP, N.Y., N.Y.
3. MO.
SLOANE MATERNITY HOSP, N.Y., N.Y.
3 mo
4. Postgraduate study since graduation from school of nursing
College, University, Clinical
Diploma
or other course
City and State
No. Months
or Degree
Major
List courses in principles of teaching
Course in practice teaching? (Type)
State teacher's certificate?
Where?
(OVER)
Page data
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- Source index
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- Type
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Document data
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- Core
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- Type
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"ocrText": "Wins,\nForm 1082\nFór Office Use Only\nRev. Dec. 1941\nAMERICAN RED CROSS\nDate of Auth\nType of Auth\nAPPLICATION FOR AUTHORIZATION TO TEACH\nChapter\nRED CROSS HOME NURSING\nState\nI. PERSONAL\nBadge JNo 4397\nName in full MISS MARY M. A. welss\nH.D.D.\n(Miss or Mrs.)\n(If married, give maiden name also)\nNot enrolled\nPresent address 1849 ANTHONY AVE., New YORK, 57, New YORK\n(street)\n(city)\n(state)\nDate of birth JAN. 22 , 1887\nSingle\ni\nMarriod\nWidowed\nDivorced\nRace White\nCitizenship American\nPresent position STAFF NURSE COMMUNITY service society\n(Title)\n(Agency)\n(City and State) N.Y,N.Y.\nII. EDUCATION\n1. Prior to entering school of nursing\nDiploma\nPSIs Name\nCity and State\nDates\nor Degree\nMajor\nHigh School aming H, S. myc x\n12TE 51-\nNormal School\n-\n-\n-\n-\nor University\nOther\nPART OF GRADE SCHOOL\n2. School of nursing\nNome N.Y. POST GRADUATE MEDICAL SCHOOL of HOSPITAL.\nLocation N.Y. N.Y.\nDate of graduation 1912\nLength of course 3 yrs.\n(city and state)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\nMANHATTAN Eye YEAR HOSP, N.Y., N.Y.\n3. MO.\nSLOANE MATERNITY HOSP, N.Y., N.Y.\n3 mo\n4. Postgraduate study since graduation from school of nursing\nCollege, University, Clinical\nDiploma\nor other course\nCity and State\nNo. Months\nor Degree\nMajor\nList courses in principles of teaching\nCourse in practice teaching? (Type)\nState teacher's certificate?\nWhere?\n(OVER)"
}