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OCR Page 1 of 68ECK, Mrs. Emily M. Kleb
Badge No. 15,646
HSR
N
Mrs.
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
[T)
m
NAME (Last, first, middle)
TELEPHONE NO.
Eck Emily maadalene
north5490
m
-
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
Emily maqdalenr Kleb
William John ECK
PERMANENT ADDRESS (Street, city, zone, county, state)
53 Adams St.n.w., Washington De.
PRESENT ADDRESS (Street, city, zone, county, state)
53 Adams St.n.w. Washington, D.C.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
W. J. Eck (husband) same address as above
Husband
E
DATE OF BIRTH (Month, day, year)
Single
Married
Divorced
July 14, 1893
Separated
Widowed
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
HIGH SCHOOL GRADUATE
English. German + some French
-
NAME OF COLLEGE OR
DEGREE OR
ULIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Teachers College Columbia Univ. n.y.City
1925-1926
Myrs. Education
Catholic University pt America, was h. LI.e.
work
B.S.degree Murs. Education
1935-1936
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
D.C.
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
Unemployed
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
HEALTH Good
IF
OTHER THAN NATURE
The purpose of the following statements is to 'identify the nurses who can be upon a call
GOOD, SPECIFY VOLUNTEER AND ANTICIPATED SERVICE DURATION OF DISABILITY counted C 7/22/116 to respond to
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 ithin the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
NO Attend an instructors' training program, if offered. (Funds are available for
YES
NO
1. Teach home
YES
nursing classes
training home nursing instructors. See local chapter.)
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.
Expect +o be away from Washington most ox the time
DATE March 9, 46
S IGNATURE
tamily K. Eck
YOUR VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN If PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NATIONAL HEADQUARTERS
NURSE RECRUITMENT
COMMITTEE
FORM 1045 Rev. July 1945
78504M
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