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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-4-33
3
Application for Enrollment
a
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1.
Name
of
applicant in full mare alice Harrie
2.
Permanent address in full 1400 avent main It Wothan, Alahama
3. Date of birth sept 28 1910 Race white
Probable address for one year 1400 west main it Walhana Ald
2"
Place of birth mobile Alar
D
Birthplace
of (Month) father lead (Day) ILS (Year) Mother (ister)
Citizenship of father U.S.
-
4. Are you single, married, a widow, or divorced? whe singlest
Are you a citizen of the United States?
ce
5. How many years have you attended Grammar school? 6 High school? 6 Normal school?
Private school? Partly College?
If tutored privately, name subjects covered and length
of time
6. What languages other than English do you speak? none
7. Occupation before entering school of nursing school. girl
(Ungerline those which you speak fluently)
8.
From what school of nursing did you receive your diploma? moody good Hospital
City and State Walkan, ala Date of graduation march 22,1931
9.
Character of Hospital: General? benual Special?
Private? yes
10. Did your training include medical and surgical care of men? yes Of women yes
Pediatrics? yrs Obstetrics? yes Communicable
diseases?
11. Daily average númber of patients in hospital during training. 50 Length of course 3
yes
years
12. Name and address of superintendent of nurses under whom you received training
mre Lda Luscar - Wosdland Duer Wathen, ala
13.
If your education as a nurse was received in more than one hospital, give name, location and time
spent in each no
14. Are you a member of your Alumnae Association? yes
15. Are you affiliated with the American Nurses' Association through membership in District and
w
State Associations? yes
Affiliation with the American Nurses' Association means active membership in the District and Graduate Nurses' Associations of
the state in which you are living at the present time.
mrs Lou Wunham, West main dt - Wathan, ala
16. Give name and address of secretary of the District or State Association of which you are a member
17. Are you a registered nurse yes In what State alaDate of registration
Number 3390
18. Type of work and length of service since graduation:
3 years private duty nursing
6 months of Country Health nursing
6
"
campbell Business Calleg
19.
Are you willing to accept service if the United States becomes involved in war? yes
20. Are you willing to take the oath of allegiance? yes
Or, service with the American Red Cross in time of disaster or great emergency? yes
21. Are you a qualified public health nurse, or teacher?
6\
If so, please answer the questions on the reverse side of this blank.
22. Give name and permanent address of nearest relative or fréend, residing in the United States
2
(state relationship)
mrs g E Harrie mother (saster)
Date March 13 - 1935 Signature of Nurse mary aboce Harree
2
To the Local Committee:
J
This blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.
forwarded to National Headquarters.
Application forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193 should be
703.
(OVER)
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"ocrText": "I\na\n=\nis\nTHE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-4-33\n3\nApplication for Enrollment\na\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1.\nName\nof\napplicant in full mare alice Harrie\n2.\nPermanent address in full 1400 avent main It Wothan, Alahama\n3. Date of birth sept 28 1910 Race white\nProbable address for one year 1400 west main it Walhana Ald\n2\"\nPlace of birth mobile Alar\nD\nBirthplace\nof (Month) father lead (Day) ILS (Year) Mother (ister)\nCitizenship of father U.S.\n-\n4. Are you single, married, a widow, or divorced? whe singlest\nAre you a citizen of the United States?\nce\n5. How many years have you attended Grammar school? 6 High school? 6 Normal school?\nPrivate school? Partly College?\nIf tutored privately, name subjects covered and length\nof time\n6. What languages other than English do you speak? none\n7. Occupation before entering school of nursing school. girl\n(Ungerline those which you speak fluently)\n8.\nFrom what school of nursing did you receive your diploma? moody good Hospital\nCity and State Walkan, ala Date of graduation march 22,1931\n9.\nCharacter of Hospital: General? benual Special?\nPrivate? yes\n10. Did your training include medical and surgical care of men? yes Of women yes\nPediatrics? yrs Obstetrics? yes Communicable\ndiseases?\n11. Daily average númber of patients in hospital during training. 50 Length of course 3\nyes\nyears\n12. Name and address of superintendent of nurses under whom you received training\nmre Lda Luscar - Wosdland Duer Wathen, ala\n13.\nIf your education as a nurse was received in more than one hospital, give name, location and time\nspent in each no\n14. Are you a member of your Alumnae Association? yes\n15. Are you affiliated with the American Nurses' Association through membership in District and\nw\nState Associations? yes\nAffiliation with the American Nurses' Association means active membership in the District and Graduate Nurses' Associations of\nthe state in which you are living at the present time.\nmrs Lou Wunham, West main dt - Wathan, ala\n16. Give name and address of secretary of the District or State Association of which you are a member\n17. Are you a registered nurse yes In what State alaDate of registration\nNumber 3390\n18. Type of work and length of service since graduation:\n3 years private duty nursing\n6 months of Country Health nursing\n6\n\"\ncampbell Business Calleg\n19.\nAre you willing to accept service if the United States becomes involved in war? yes\n20. Are you willing to take the oath of allegiance? yes\nOr, service with the American Red Cross in time of disaster or great emergency? yes\n21. Are you a qualified public health nurse, or teacher?\n6\\\nIf so, please answer the questions on the reverse side of this blank.\n22. Give name and permanent address of nearest relative or fréend, residing in the United States\n2\n(state relationship)\nmrs g E Harrie mother (saster)\nDate March 13 - 1935 Signature of Nurse mary aboce Harree\n2\nTo the Local Committee:\nJ\nThis blank is to be sent to applicant with circular letter Form 1199, together with Forms 2, 1193 and A. R. C.\nforwarded to National Headquarters.\nApplication forms after approval and endorsement by Local Committee, with Forms 1244, 1189, and 1193 should be\n703.\n(OVER)\nBest Available Image"
}