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FORM 1219
REV,AUG.1941
Date Auth
AMERICAN RED CROSS
Type of Auth
Chapter
APPLICATION FORM
Return to Miss Dunbar
State
SERVICE IN HAWAII
Nursing Service
Confidential
and
RED CROSS MOME NURGINO INSTRUCTOR
Please return
I. PERSONAL
Date January 23.1942
Name in full miss Helen Aldine mcnutt
Badge (No.42658
(H.D.
(MISS OR MRS)
(IF MARRIED, GIVE MAIDEN NAME)
Present address 613 PaRK ST. Willard Ohio Tel. No. 6303
Not enrolled
(STREET)
(CITY)
(STATE)
Permanent address 2505 173rd ST Hammand Ind Tel. No. 6473R
(STREET)
(CITY)
(STATE)
e
Date of birth March 31-1898
Marital status Single
(BINGLE, MARRIED, WIDOWED, DIVORCED)
Race White
Citizenship American
II. EDUCATION
1. Prior to entering school of nursing
Diploma
Name
City and State
Dates
or Degree
Major
High School Hammond H.S. Hammand Ind 1916 Diploma
Normal School
or University
Other
2. School of nursing from which you graduated
[stuH
Name Illinois Training School Cook CounTry stugp.
Location Chicago Ill Date of graduation 1723 Length of course 3yrs
(CITY ANDI STATE)
3. Undergraduate affiliations
Length of
Hospital or Organization
City and State
Type
time spent
4. Academic study since graduation from school of nursing
College or University or
Diploma
postgraduate course
City and State No Months
or Degree
Major
2 )
own addition
What courses in principles of teaching have you had?
2
Have you had a course in practice teaching?
6
Do you hold a state teacher's certificate?
Where
Do you speak a foreign language?
5
(Over)
8
Page data
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- Type
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- Media ID
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Document data
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- Core
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- Type
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DTO data
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"ocrText": "For Office Use Only\nproperty\nPhysical read\nFORM 1219\nREV,AUG.1941\nDate Auth\nAMERICAN RED CROSS\nType of Auth\nChapter\nAPPLICATION FORM\nReturn to Miss Dunbar\nState\nSERVICE IN HAWAII\nNursing Service\nConfidential\nand\nRED CROSS MOME NURGINO INSTRUCTOR\nPlease return\nI. PERSONAL\nDate January 23.1942\nName in full miss Helen Aldine mcnutt\nBadge (No.42658\n(H.D.\n(MISS OR MRS)\n(IF MARRIED, GIVE MAIDEN NAME)\nPresent address 613 PaRK ST. Willard Ohio Tel. No. 6303\nNot enrolled\n(STREET)\n(CITY)\n(STATE)\nPermanent address 2505 173rd ST Hammand Ind Tel. No. 6473R\n(STREET)\n(CITY)\n(STATE)\ne\nDate of birth March 31-1898\nMarital status Single\n(BINGLE, MARRIED, WIDOWED, DIVORCED)\nRace White\nCitizenship American\nII. EDUCATION\n1. Prior to entering school of nursing\nDiploma\nName\nCity and State\nDates\nor Degree\nMajor\nHigh School Hammond H.S. Hammand Ind 1916 Diploma\nNormal School\nor University\nOther\n2. School of nursing from which you graduated\n[stuH\nName Illinois Training School Cook CounTry stugp.\nLocation Chicago Ill Date of graduation 1723 Length of course 3yrs\n(CITY ANDI STATE)\n3. Undergraduate affiliations\nLength of\nHospital or Organization\nCity and State\nType\ntime spent\n4. Academic study since graduation from school of nursing\nCollege or University or\nDiploma\npostgraduate course\nCity and State No Months\nor Degree\nMajor\n2 )\nown addition\nWhat courses in principles of teaching have you had?\n2\nHave you had a course in practice teaching?\n6\nDo you hold a state teacher's certificate?\nWhere\nDo you speak a foreign language?\n5\n(Over)\n8"
}