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FORM NO. 1
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
I Louisa White
1.
Name of applicant
Badge number
2. Address in full 806-52 nd st oakland Cal
42
3. Date of birth June 13- 1874 Place of birth Bath, Retaris, Canada
4. Are you married, single or a widow?
Single
Are you a citizen of the United States?
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no
yes
6.
Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated Graduated from Virginia City
High School Virguice lity, nevada.
7.
Occupation before entering training school Teaching school
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
Protestaus Episcopae Hospital, Philadelphia, Pa., 1902
9. Character of hospital: General yrs
Special ?
-
Private ?
10. Daily average number of patients in hospital during training
300
Length of course 3 yrs
11. Name and address of superintendent of training school under whom you received training
many S. Littleffield - do not Kurn present address
12.
Of what nursing organizations are you a member ? P.E.H. alumnee; alamedu Co. mursis
asin; National Curgue of nursing Education
13. Give name and address of secretary of at least one of these organizations miss Lauder Protestant
Hospitar, Phil.; mrs. H. D. Beel Peiu 1648 Grand am reneared, Cal.
14. Are you a registered nurse ? yes In what state
? cal.
Date of registration Pewa, 1911; Cal., 1914.
15. State how, where and for whatUperiod of time, in each instance, you have been employed since graduation,
including present employment Supt. of nurses 5yrs, Keopville Guil Horp. Kicoxville, Jeun
supr. St Peters Hospital, 6 no, Charlotte U.C;
Suph f nurses, 5 yrs, mirritt Hospital outluned, Cal.;
Supri of Baby Hospital, / yr. ourland, Cae,
not employed at present
16. In the event of war are you willing to take the oath of allegiance ?
yes
17. Name and permanent address of nearest relative John Blete father
806 - 52 ul It, ourleand Cae
Date June r, 1916
Signature Lillian L. White
This blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee
to be forwarded with credentials " (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c.
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"ocrText": "FORM NO. 1\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nI Louisa White\n1.\nName of applicant\nBadge number\n2. Address in full 806-52 nd st oakland Cal\n42\n3. Date of birth June 13- 1874 Place of birth Bath, Retaris, Canada\n4. Are you married, single or a widow?\nSingle\nAre you a citizen of the United States?\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no\nyes\n6.\nName educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated Graduated from Virginia City\nHigh School Virguice lity, nevada.\n7.\nOccupation before entering training school Teaching school\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\nProtestaus Episcopae Hospital, Philadelphia, Pa., 1902\n9. Character of hospital: General yrs\nSpecial ?\n-\nPrivate ?\n10. Daily average number of patients in hospital during training\n300\nLength of course 3 yrs\n11. Name and address of superintendent of training school under whom you received training\nmany S. Littleffield - do not Kurn present address\n12.\nOf what nursing organizations are you a member ? P.E.H. alumnee; alamedu Co. mursis\nasin; National Curgue of nursing Education\n13. Give name and address of secretary of at least one of these organizations miss Lauder Protestant\nHospitar, Phil.; mrs. H. D. Beel Peiu 1648 Grand am reneared, Cal.\n14. Are you a registered nurse ? yes In what state\n? cal.\nDate of registration Pewa, 1911; Cal., 1914.\n15. State how, where and for whatUperiod of time, in each instance, you have been employed since graduation,\nincluding present employment Supt. of nurses 5yrs, Keopville Guil Horp. Kicoxville, Jeun\nsupr. St Peters Hospital, 6 no, Charlotte U.C;\nSuph f nurses, 5 yrs, mirritt Hospital outluned, Cal.;\nSupri of Baby Hospital, / yr. ourland, Cae,\nnot employed at present\n16. In the event of war are you willing to take the oath of allegiance ?\nyes\n17. Name and permanent address of nearest relative John Blete father\n806 - 52 ul It, ourleand Cae\nDate June r, 1916\nSignature Lillian L. White\nThis blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee\nto be forwarded with credentials \" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c."
}