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FORM NO. 1
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
1. Name of applicant
Address in full 37.8.21 al street new York City Lel. 1613 Lennoy
Helen young
Badge number
2.
35
3. Date of birth have 17 (18 79)
Place of birth Chalham Ontaris
4. Are you married, single or a widow? Single
Are you a citizen of the United States? no
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? None
6. Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated Charham Collegiate Institute Ontaris
normal College
7. Occupation before entering training school
Teacher.
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
Prechyterism Nosfillet Training School for hurses Class 1912 New York City
9. Character of hospital: General
Special?
Private?
10. Daily average number of patients in hospital during training 230
Length of 3 yrs
course
11. Name and address of superintendent of training school under whom you received training
miss anna C. maxwell 378.71 new York City
12. Of what nursing organizations are you a member ? alumni Association of
Presby terian Laining School for nurses
13. Give name and address of secretary of at least one of these organizations
Edith Evanger Fenimore Ave. Brooklyn
14. Are you a registered nurse ? year In what state ? New York Date of registration 1913
15. State how, where and for what period of time, in each instance, you have been employed since graduation,
including present
employment Head nurse on Women's Surgical
loard 9 months Head musos on Women's medical
wands a year and As half Both position in
Hospital new York City
16. In the event of war are you willing to take the oath of allegiance ?
yes
17. Name and permanent address of nearest relative
Johns Lo. Young
249 Vedloria ave, Chatham. Ond. Canada
Date Dec. 9.14
Signature
Nelen Young.
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)\n1. Name of applicant\nAddress in full 37.8.21 al street new York City Lel. 1613 Lennoy\nHelen young\nBadge number\n2.\n35\n3. Date of birth have 17 (18 79)\nPlace of birth Chalham Ontaris\n4. Are you married, single or a widow? Single\nAre you a citizen of the United States? no\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? None\n6. Name educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated Charham Collegiate Institute Ontaris\nnormal College\n7. Occupation before entering training school\nTeacher.\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\nPrechyterism Nosfillet Training School for hurses Class 1912 New York City\n9. Character of hospital: General\nSpecial?\nPrivate?\n10. Daily average number of patients in hospital during training 230\nLength of 3 yrs\ncourse\n11. Name and address of superintendent of training school under whom you received training\nmiss anna C. maxwell 378.71 new York City\n12. Of what nursing organizations are you a member ? alumni Association of\nPresby terian Laining School for nurses\n13. Give name and address of secretary of at least one of these organizations\nEdith Evanger Fenimore Ave. Brooklyn\n14. Are you a registered nurse ? year In what state ? New York Date of registration 1913\n15. State how, where and for what period of time, in each instance, you have been employed since graduation,\nincluding present\nemployment Head nurse on Women's Surgical\nloard 9 months Head musos on Women's medical\nwands a year and As half Both position in\nHospital new York City\n16. In the event of war are you willing to take the oath of allegiance ?\nyes\n17. Name and permanent address of nearest relative\nJohns Lo. Young\n249 Vedloria ave, Chatham. Ond. Canada\nDate Dec. 9.14\nSignature\nNelen Young.\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."
}