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FORM 1037
AMERICAN RED CROSS NURSING SERVICE
REV. FEB. 1941
3628
APPLICATION FOR ENROLLMENT
aton
I
(To be filled out in applicant's handwriting and each question answered fully)
House
1. Name of applicant in full
If married, give maiden name 36.28 are st
Thomas Elizabeth Wright R.N., B.A.
2. Permanent address
3177 (Street) ST (City) (County) Houston Harris
3. Probable address for one year
(State) Texas
(Street)
(City)
(County)
(State)
4. Name and permanent address of nearest relative or friend residing in the United States:
mrs. O. n. Wright - 3177 maynolia ST Copera (Relationship) chusti Jay
mother
5. Race
6. Present Marital Status
7. Citizenship
8. What languages other than English do you
speak?
White
1 Single
Native born
None
Negro
Married
Naturalized
Spanish
little
German little
Scandinavian
Other
Widowed
Non citizen
French
Polish
Divorced
Italian
Other
Catholic Sister
9. Date of birth Oct., 31, 1941
Place of birth Banqueth sexos
Is Father a citizen of the
Yes
United States?
No
10. General education (prior to entering nursing):
Did you graduate from high school
Yes
If no, how many years of high school do you lack?
No
What college or university education did you have prior to entering nursing?
None or less
1 year;
2 years;
3 years;
Bachelors
Masters
PH.D.
than 1 year;
Degree;
Degree;
11. Nursing Education:
a. School of nursing from which
graduated
Seton 200.22 (Name) 1922 austin (City) Texas (State)
Date of graduation
Length of course:
25 years; 3 years;
(Specify Other)
b. Undergraduate affiliations:
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
(3)
c. Postgraduate clinical courses (Do not include academic work or employment)
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
(3)
d. Academic study since graduation from School of Nursing:
College or University
City and State
Number of full time
Number of
(1) St.mary's collige Deather Dame, Ind
academic years
points
4
130
(2)
(3)
e. Check all degrees obtained
Bachelors
Masters
PH. D.
Certificate in Public Health
subsequent to entering training:
Degree;
Degree;
Nursing
f. In which major field was your academic study? Institutional
Public Health
Non nursing (specify)
Other (specify)
(Over)
major 1 nursing Education
minor nursing Education
Page data
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- Type
- photo
- Media ID
- 5c389887dd66665e
- Size
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Document data
- ID
- 2662521
- Core
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- Type
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"ocrText": "FORM 1037\nAMERICAN RED CROSS NURSING SERVICE\nREV. FEB. 1941\n3628\nAPPLICATION FOR ENROLLMENT\naton\nI\n(To be filled out in applicant's handwriting and each question answered fully)\nHouse\n1. Name of applicant in full\nIf married, give maiden name 36.28 are st\nThomas Elizabeth Wright R.N., B.A.\n2. Permanent address\n3177 (Street) ST (City) (County) Houston Harris\n3. Probable address for one year\n(State) Texas\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nmrs. O. n. Wright - 3177 maynolia ST Copera (Relationship) chusti Jay\nmother\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nspeak?\nWhite\n1 Single\nNative born\nNone\nNegro\nMarried\nNaturalized\nSpanish\nlittle\nGerman little\nScandinavian\nOther\nWidowed\nNon citizen\nFrench\nPolish\nDivorced\nItalian\nOther\nCatholic Sister\n9. Date of birth Oct., 31, 1941\nPlace of birth Banqueth sexos\nIs Father a citizen of the\nYes\nUnited States?\nNo\n10. General education (prior to entering nursing):\nDid you graduate from high school\nYes\nIf no, how many years of high school do you lack?\nNo\nWhat college or university education did you have prior to entering nursing?\nNone or less\n1 year;\n2 years;\n3 years;\nBachelors\nMasters\nPH.D.\nthan 1 year;\nDegree;\nDegree;\n11. Nursing Education:\na. School of nursing from which\ngraduated\nSeton 200.22 (Name) 1922 austin (City) Texas (State)\nDate of graduation\nLength of course:\n25 years; 3 years;\n(Specify Other)\nb. Undergraduate affiliations:\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nd. Academic study since graduation from School of Nursing:\nCollege or University\nCity and State\nNumber of full time\nNumber of\n(1) St.mary's collige Deather Dame, Ind\nacademic years\npoints\n4\n130\n(2)\n(3)\ne. Check all degrees obtained\nBachelors\nMasters\nPH. D.\nCertificate in Public Health\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study? Institutional\nPublic Health\nNon nursing (specify)\nOther (specify)\n(Over)\nmajor 1 nursing Education\nminor nursing Education"
}