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Form 1082
AMERICAN NATIONAL RED CROSS
Rev. 6-18-29
HOME HYGIENE AND CARE OF THE SICK SERVICE
Ke's
K
5
INSTRUCTOR'S APPLICATION
e
I.
Pleasé fill out this form
and RETURN TO Home Hygiene and Care of the Sick Service
S
1. PERSONNEL INFORMATION:
(b
Name in full Grilk, Katherine Louise
Red Cross Badge No.
22882
Present address 3879 Edenhurst
Date of birth June 30, 1895
Are you single, married, separated, widowed or divorced? Married
State condition of heal th
Very Good
e
If applying for a position state your preference and limitations as to locality
2. PROFESSIONAL EDUCATION:
Name of training school
Grant Hospital
Location Columbus, Ohio
May, 1918
Date of graduation
Registration Michigan
11919
Citizenship
American born
(State)
(Year)
Postgraduate work
(Hospital)
(Types of work)
(Date)
If not an enrolled Red Cross nurse, have application papers been submitted to Local
Red Cross Nursing Committee?
3. EDUCATION:
Diplomas and
Name and location
Dates attending
degrees rec'd.
High school
or equivalent
Woodlake Minn.
1906-1907
Normal
Mankato Normal
1908-1909
College (Sp. work) At Summer Sessions Winslow Lectures 1927
Institute for P.H.N. Dr. BIY ant 1928
Summer schools
Psychology credit 3 2 A.B.C. 9/29 to 2/30
Special course in
2
principles of teaching Detroit Teachers College
2 hrs.
Summer 1921
2
Did above course include practice teaching No
Do you hold a State teacher's certificate?
In what State?
8
PLEASE ANSWER QUESTIONS ON REVERSE SIDE
29666
8
2
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Document data
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"ocrText": "a\nE\nForm 1082\nAMERICAN NATIONAL RED CROSS\nRev. 6-18-29\nHOME HYGIENE AND CARE OF THE SICK SERVICE\nKe's\nK\n5\nINSTRUCTOR'S APPLICATION\ne\nI.\nPleasé fill out this form\nand RETURN TO Home Hygiene and Care of the Sick Service\nS\n1. PERSONNEL INFORMATION:\n(b\nName in full Grilk, Katherine Louise\nRed Cross Badge No.\n22882\nPresent address 3879 Edenhurst\nDate of birth June 30, 1895\nAre you single, married, separated, widowed or divorced? Married\nState condition of heal th\nVery Good\ne\nIf applying for a position state your preference and limitations as to locality\n2. PROFESSIONAL EDUCATION:\nName of training school\nGrant Hospital\nLocation Columbus, Ohio\nMay, 1918\nDate of graduation\nRegistration Michigan\n11919\nCitizenship\nAmerican born\n(State)\n(Year)\nPostgraduate work\n(Hospital)\n(Types of work)\n(Date)\nIf not an enrolled Red Cross nurse, have application papers been submitted to Local\nRed Cross Nursing Committee?\n3. EDUCATION:\nDiplomas and\nName and location\nDates attending\ndegrees rec'd.\nHigh school\nor equivalent\nWoodlake Minn.\n1906-1907\nNormal\nMankato Normal\n1908-1909\nCollege (Sp. work) At Summer Sessions Winslow Lectures 1927\nInstitute for P.H.N. Dr. BIY ant 1928\nSummer schools\nPsychology credit 3 2 A.B.C. 9/29 to 2/30\nSpecial course in\n2\nprinciples of teaching Detroit Teachers College\n2 hrs.\nSummer 1921\n2\nDid above course include practice teaching No\nDo you hold a State teacher's certificate?\nIn what State?\n8\nPLEASE ANSWER QUESTIONS ON REVERSE SIDE\n29666\n8\n2"
}