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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
J.
in
el
n
14 DESTROYED
Dear Red Cross Nurse:
"
11/01/15
e
3
/'
The National Committee on Red Cross Nursing Service requires us to submit,
P
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
In order to render prompt service
Yours
Galla / Chairman
or
NAME OF NURSE
Hiagkand Jennies
NO
3770
NAME OF NEAREST RELATIVE
John E. Hoagland
ADDRESS
Idaville Ind.
RELATIONSHIP
aduress ror the next
year 4haz Vh
(STREET, ETC.)
Telephone No. And 2683
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Brother dR Hougland Callon Ry 240WHarrison so Chicasocking
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
anesthetics
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? nc
Have you ever been? no
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.'
yes
Badge No. 3770
Current date april 9th 1938
NOTE. - If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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"ocrText": "I\n0\nFORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nJ.\nin\nel\nn\n14 DESTROYED\nDear Red Cross Nurse:\n\"\n11/01/15\ne\n3\n/'\nThe National Committee on Red Cross Nursing Service requires us to submit,\nP\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nIn order to render prompt service\nYours\nGalla / Chairman\nor\nNAME OF NURSE\nHiagkand Jennies\nNO\n3770\nNAME OF NEAREST RELATIVE\nJohn E. Hoagland\nADDRESS\nIdaville Ind.\nRELATIONSHIP\naduress ror the next\nyear 4haz Vh\n(STREET, ETC.)\nTelephone No. And 2683\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nBrother dR Hougland Callon Ry 240WHarrison so Chicasocking\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nanesthetics\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? nc\nHave you ever been? no\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.'\nyes\nBadge No. 3770\nCurrent date april 9th 1938\nNOTE. - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}