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McCoy, Elizabeth G., Badge #61,968
chd. to Ceterson 7/3/ ek
RED CROSS BADGE NUMBER
8/11-mR
AMERICAN RED CROSS
NURSING SERVICES
2
61 968
MILITARY SERIAL NUMBER
-
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
Nots other
side
9
NAME (Last, first, middle)
McCoy, Elizabeth Graham
6
Ext.
$13
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
Walter E. Willis
.3
-
PERMANENT ADDRESS (Street, city, zone, county, state)
Amer. Red Cross - 18th & E Sts., NW, Washington, D.C.
PRESENT ADDRESS (Street, city, zone, county, state)
"
"
"
"
FIX
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Mrs. Hazel B. McCoy - 514 E. Main St., Greensburg, Indiana
mother
DATE OF BIRTH (Month, day, year)
Single
Married
Widowed
Divorced
Oct. 22, 1909
Separated
#
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
HIGH SCHOOL GRADUATE
no
#
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Univ. of Cincinnati
Cincinnati, Ohio
1926 - 32
B.S.
nursing
Western Reserve Univ.
Cleveland, Ohio
19 35
M.S. public health nursin
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
"
REGISTERED?
Ohio
NURSES' ASSOCIATION?
#
PRESENT EMPLOYMENT If not ,employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
Asst. Dir., Home Nursing
public health nursing
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
Amer. Natl. Red Cross
Washington
D.C.
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
Good
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
- don't know
1. Teach home
YES
NO Attend an instructors' training program, 1f offered. (Funds are available for
YES
NO
nursing classes
#
training home nursing instructors. See local chapter.)
!already
trained
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of d!saster
#
In other communities
offered, in preparation for service
#
3. Teach nurse's
YES
NO
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chapter
YES
NO
aide classes
#
mittee should services be needed
#
programs, as needed
#
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS-
-
DATE
SIGNATURE
Aug. 10, 1945
YOUR
VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS
IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
COMMITTEE
from
HEADQUARTERS
78504M
FORM 1045 Rev. July 1945
Page data
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- Type
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Document data
- ID
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- Core
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- Type
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DTO data
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"ocrText": "McCoy, Elizabeth G., Badge #61,968\nchd. to Ceterson 7/3/ ek\nRED CROSS BADGE NUMBER\n8/11-mR\nAMERICAN RED CROSS\nNURSING SERVICES\n2\n61 968\nMILITARY SERIAL NUMBER\n-\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNots other\nside\n9\nNAME (Last, first, middle)\nMcCoy, Elizabeth Graham\n6\nExt.\n$13\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nWalter E. Willis\n.3\n-\nPERMANENT ADDRESS (Street, city, zone, county, state)\nAmer. Red Cross - 18th & E Sts., NW, Washington, D.C.\nPRESENT ADDRESS (Street, city, zone, county, state)\n\"\n\"\n\"\n\"\nFIX\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMrs. Hazel B. McCoy - 514 E. Main St., Greensburg, Indiana\nmother\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nWidowed\nDivorced\nOct. 22, 1909\nSeparated\n#\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nHIGH SCHOOL GRADUATE\nno\n#\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nUniv. of Cincinnati\nCincinnati, Ohio\n1926 - 32\nB.S.\nnursing\nWestern Reserve Univ.\nCleveland, Ohio\n19 35\nM.S. public health nursin\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\n\"\nREGISTERED?\nOhio\nNURSES' ASSOCIATION?\n#\nPRESENT EMPLOYMENT If not ,employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nAsst. Dir., Home Nursing\npublic health nursing\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nAmer. Natl. Red Cross\nWashington\nD.C.\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nGood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n- don't know\n1. Teach home\nYES\nNO Attend an instructors' training program, 1f offered. (Funds are available for\nYES\nNO\nnursing classes\n#\ntraining home nursing instructors. See local chapter.)\n!already\ntrained\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof d!saster\n#\nIn other communities\noffered, in preparation for service\n#\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\n#\nmittee should services be needed\n#\nprograms, as needed\n#\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS-\n-\nDATE\nSIGNATURE\nAug. 10, 1945\nYOUR\nVALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS\nIN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nfrom\nHEADQUARTERS\n78504M\nFORM 1045 Rev. July 1945"
}