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D M R 1 THE AMERICAN RED CROSS DEPARTMENT OF NURSING Application for Enrollment (To be filled out entirely in applicant's handwriting and each question answered fully.) 1. Name of applicant in full Miss Mrtts P.Cottnel 2. Address in full, Street 3/47 Prispect Citt Clintay State Calin M The 3. 4. or a 5. Have you any physical defects or tendency to constitutional or pulmonary trouble ? no Are Date you of birth married July single widow 17-18-22 ? Biugh Place of birth citizen millioughly of Ohio Are you a the United States? you Are you physically strong and healthy ? yas 6. Name educational institutions attended before entering training school, stating number of years at each and from you were 7. What than you millionghly, languages other English do speak? June which graduatede. alio Craduated from High Rehnold P. 8. Occupation before entering training school Clunk 9. From and what state hospital Clarland training schpol did you Chio receive your Date diploma of graduation ? It Vincepts City 11. 12. 10. Did Daily Character your average training of hospital: number include of General obstetrics/ patients ? topic hospital during Care of men Special ? ? Children you Contagious Private ? diseases 3years ? in training Length of course 13. Name and address of superintendent of training school under whom you received Araining Rifter many Marcallin, Charity Hospital, 22 we Central clan 14. a nurse was received in/ more than one hospital, give name, locat on and time spent in eath of If Abstrtries, your trating as 3 months, Rtanne Mat And 35th Moodland 15. Qf what nursing organizations are you a member? am national state, Charion 16. Which, If any, is affiliated with the American Nurses Association Hospital Alumnar, Public Araleli all. club Unitany unife are 17. Give name and address of secretary of at least one of these organizations 18. 19. Public How and Hally male Are you a registered nurse the Use In what state ? Ohis Date of registration injury 11.16 Number 546. where employed sinde graduation: Give dates with months: Name md address of employere Refert. 50 lad. sospital 24 months monthg 12 Visiting musselves. clml 4 months Eddy Road HARP. Industrial nork addistrial walk 18 months Feero mash A Welcom nut Recaptompth. 2 Private maning 412 years charity properts Central. 22ngt - a (Specify for which of the following services you wish to be considered.) 20. War service, wherever needed am Rear When available Rept lot 1918 Room is wonded if 5 21. Instructor, Are you willing Elementary to take the Hygiene oath of allegiance? yrs of nearest relative Mr. & me gmm C.C. / Cathel malia or for War Service noting 22. Public Health Nursing In Town and Country Nursing Service, 23. Name and permanent address 20 Wright net Date the h able Signature Clattell milloughly of Nurse Calvio To Committee: melBalan earn This blank is to be sent to applicant with circular letter D. M. R. 7; together with Forms D. M. R. 2, 11, 29 and after and A. R. approval C. 150. Application and endorsement forms by (except Local Committee, of a nurse desiring with credentials to (Forms 3 and 4), together with Forms Service) 10 enroll for the Town and Country Nursing 11, should be forwarded through the Director of the Bureau of Nursing in your Division to the Department of Nursing, American Red Cross, Washington, D. C. In case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washing- ton by the Local Committee, from whence credentials will be procured if possibly, Lind together 13 year.

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    "ocrText": "D M R 1\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1. Name of\napplicant in full Miss Mrtts P.Cottnel\n2. Address in full, Street\n3/47 Prispect Citt\nClintay State Calin\nM\nThe\n3.\n4. or a\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble ? no\nAre Date you of birth married July single widow 17-18-22 ? Biugh\nPlace of birth citizen millioughly of Ohio\nAre you a the United States?\nyou\nAre you physically strong and healthy ?\nyas\n6. Name educational institutions attended before entering training school, stating number of years at each and\nfrom you were\n7. What than you\nmillionghly, languages other English do speak? June\nwhich graduatede. alio Craduated from High Rehnold\nP.\n8. Occupation before entering training school\nClunk\n9. From\nand what state hospital Clarland training schpol did you Chio receive your Date diploma of graduation ? It Vincepts\nCity\n11. 12. 10. Did Daily Character your average training of hospital: number include of General obstetrics/ patients ? topic hospital during Care of men Special ? ? Children you Contagious Private ? diseases 3years ?\nin training Length of course\n13.\nName and address of superintendent of training school under whom you received Araining Rifter many\nMarcallin, Charity Hospital, 22 we Central clan\n14. a nurse was received in/ more than one hospital, give name, locat on and time spent in eath\nof\nIf Abstrtries, your trating as 3 months, Rtanne Mat And 35th Moodland\n15. Qf\nwhat nursing organizations are you a member? am national state, Charion\n16. Which, If any, is affiliated with the American Nurses Association\nHospital Alumnar, Public Araleli all. club Unitany unife are\n17. Give name and address of secretary of at least one of these organizations\n18.\n19.\nPublic How and Hally male\nAre you a registered nurse the Use In what state ? Ohis Date of registration injury 11.16 Number 546.\nwhere employed sinde graduation:\nGive dates with months:\nName md address of employere\nRefert. 50 lad. sospital\n24 months monthg\n12\nVisiting musselves. clml\n4 months\nEddy Road HARP.\nIndustrial nork\naddistrial walk\n18 months\nFeero mash A\nWelcom nut Recaptompth.\n2\nPrivate maning\n412 years\ncharity properts Central. 22ngt\n-\na\n(Specify for which of the following services you wish to be considered.)\n20.\nWar service, wherever needed am Rear When available\nRept lot 1918\nRoom is wonded if\n5\n21.\nInstructor, Are you willing Elementary to take the Hygiene oath of allegiance? yrs\nof nearest relative Mr. & me\ngmm C.C. / Cathel malia\nor for War Service noting\n22. Public Health Nursing\nIn Town and Country Nursing Service,\n23. Name and permanent address\n20 Wright net\nDate the h able Signature Clattell\nmilloughly of Nurse Calvio\nTo\nCommittee: melBalan earn\nThis blank is to be sent to applicant with circular letter D. M. R. 7; together with Forms D. M. R. 2, 11, 29 and\nafter and\nA. R. approval C. 150. Application and endorsement forms by (except Local Committee, of a nurse desiring with credentials to (Forms 3 and 4), together with Forms Service) 10\nenroll for the Town and Country Nursing\n11, should be forwarded through the Director of the Bureau of Nursing in your Division to the Department of Nursing,\nAmerican Red Cross, Washington, D. C.\nIn case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent\nto the Local Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washing-\nton by the Local Committee, from whence credentials will be procured\nif possibly, Lind together 13 year."
}