Service Enrollment Application

(p) Names of all relatives nearer than second cousins in the war service of the United States Government. John Holobird, Col. U. S. Army 1st cousin It. Col. Cruikshank, II. S. Army 1st cousin by marriage 5. If foreign born, give date and court of your naturalization No 6. Single, married, widow, or widower Single (a) Number of dependents None (b) Full name and address of nearest relative or friend Mrs. Agnes T. von Kurowsky (Mother) 1437 Clifton St. N.W. Washington, D. C. (c) Full name of wife before marriage; or husband (d) Birthplace of wife or husband (e) Nationality of wife or husband (f) Birthplace and nationality of father of wife or husband (g) Birthplace and nationality of mother of wife or husband 7. Kind of service preferred. (Specify.) Foreign service with Red Cross 8. Would you enter foreign service? Yes (a) If so, in what country or countries? Italy (b) Describe fully any experience you have ever had in service of the American Red Cross. 9. Would you serve without pay and defray all of your necessary expenses? (a) With only expenses defrayed for you? (b) If not, what minimum salary would you require in addition to the defraying of your expenses? IO. What University or College attended? Year graduated II. Can you speak French fluently? (a) If not, to what degree, if any? fair amount (b) Can you translate French easily? (c) If not, to what degree, if any? slightly 12. What other foreign languages do you speak? Slight amount of German (a) State extent of your knowledge of each 13. As references, give names and addresses of three American citizens not related to you. Miss Amy M. Hilliard, Supt. Bellevue & Allied Training Schools, N. Y. Mrs. Charles D. Lee 1628 Swain St. Washington, D. C. Dr. David V. Meyers, Bellevue Hospital, New York 14. Give names and addresses of all patriotic, beneficial, social or other form of clubs, societies or other organizations based on race, nationality, etc., to which you belong or have at any time belonged, since August I, 1914. Bellevue Alumnae Association, Address, Osborn Hall, 426 Eastm26th St. New York City. 15. If enrolled in service, name earliest date you could take up work Ready for immediate service I hereby certify that the answers to the above questions are correct to the best of my knowledge and belief. Agnes H. van Kurowsky Signature. Division Personnel Committee examining application Atlantic Date of report May 13, 1918 Report of Committee. (Be specific.) talked on phone with Miss Hilliard and Dr. Meyers both of whom gave Missyon Kurowsky the best recommendations possible Date of receipt at National Headquarters Checked by Comments: