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{
    "localId": "2661368",
    "label": "Disney, Mrs. Evangelyn H. nee Evangelyn H. Mosher",
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    "id": "2661368",
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    "contentType": "document",
    "title": "Disney, Mrs. Evangelyn H. nee Evangelyn H. Mosher",
    "citationUrl": "https://catalog.archives.gov/id/2661368",
    "collections": [
        "Records of the American National Red Cross",
        "Historical Nurse Files"
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    "coverageEndDate": {
        "day": 9,
        "logicalDate": "1945-09-09",
        "month": 9,
        "year": 1945
    },
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        "day": 5,
        "logicalDate": "1917-09-05",
        "month": 9,
        "year": 1917
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    "seq": 9,
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    "ocrText": "N\nD\ne.\ncier\n(A\nS\n&\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n135 w\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nbelongs\nMrs\n1\nTEVEPHONE NO.\nS.\nNAME (Last, first, middle)\nIF MARRIED, GIVE MAIDEN NAME\nDishey Evangelyn. A M\n276\nmosher\nHUSBAND'S NAME\nCharles Disney\nE\nPERMANENT ADDRESS (Street, city, zone, county state)\nL\nPRESENT ADDRESS (Street,\nDelhi - mened city, zone, county, Cu- Calif state)\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nHusband - Chaels Dishay\nor\nDATE OF BIRTH (Month, day, year)\nSingle\nMa\nSeparated\nWidowed\nDivorced\nSep 30-1892\n-\n-\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\nL\nS\n+\nEnglish -\nNAME OF COLLEGE OR\nDEGREE OR\nn\nUNIVERSITY ATTENDED\n-\nLOCATION\n-\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\n1\nI\nARE YOU CURRENTLY\nYES,\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES,\nNO\nX\nCalij\nNURSES' ASSOCIATION?\nREGISTERED?\nye\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.).\nHead nuise\nPreventrium CITY t Guaray STATE\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM, EMPLOYED\nBloss IF Memorial OTHER GOOD, Hospital\natw ate\nTHAN SPECIFY UTURE AND ANTICIPATED DURATION OF DISABILITY\nCalifornia\nHEALTH\n9004\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\n1. Teach home\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2.\nServe in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nIn other communities\noffered, in preparation for service\nof disaster\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\na\naide classes\nL\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJ OR REASONS,\nDATE\nemployed\nS\n9 19-45\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS\nIGNATURE Evazelyn ro SERVE AND YOUR my FAITHPOLNESS strong IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nSECRETARY\n2823 Fresus st. Fresno, californias\nFill in committee name and address before sending questionnaire to nurse.\nNURSE RECRUITMENT\nCOMMITTEE\nFORM 1045 Rev. July 1945\n78504M"
}