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FORM NO. 1
THE MERICAN RED COOSE
WASHINGTON
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
I.
Name of applicant in full Wazel Gertrude Brunor
2. Address in full
yst.
2401 Sacromento St. San Francisco - Caly.
3.
Date of birth
august 7- 1891
Place of birth Santa Rosa. Caly
4. Are you married, single or a widow?
Single
Are you a citizen of the United States?
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
none
yes,
6. Name educational institutions attended before entering training school, stating number of years at each and from which you
Santa were graduated Rosa Santa High Rosa S chool- Grammar graduated School and
7. Occupation before entering training school none
8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation
from Lane Hap ital Training School - 1913
San Francisco - ealy onnia
9.
If your training as a nurse was received in more than one hospital, give name, location and time spent in each
IO.
Character of hospital: General? yes
Special?
Private? -
II. Did your training include the care of men? yes
Contagious diseases?
no
Obstetrics? yes
12. Daily average number of patients in hospital during training
150
Length of course
syre.
13. Name and address of superintendent of training school under whom you received training
miss Harriet m= arthur - Presp. Hospital new York
14. Of what nursing organizations are you a member?
Land Hospital alumnian
15. Which, if any, is affiliated with the American Nurses Association?
Lane Alumni
16.
Give name and address of secretary of at least one of these organizations. miss Klute , San mate
Caly onnia Secretary Rane Clumni
17. Are you a registered nurse? yes
In what state? Calif Date of registration 1914
18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present
employment
Private duty during I yrs.
19. Should our country be involved in war, would you be available for active service? yes
20. Would you be willing to take the oath of allegiance?
yes
21. What languages other than English do you speak?
none
22. Name and permanent address of nearest relative mr. e.m Bruner. 421 Second St.
Date march 16- 1917
Santa Rosa Caly
Signature Hazel g. Bruner.
This blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. After
approval and endorsement by local Committee to be forwarded with "credentials" (Forms Nos. 3 and 4) together with Forms 10-11 to the
Chairman, National Committee on Red Cross Nursing Service, Washington, D. C.
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"ocrText": "FORM NO. 1\nTHE MERICAN RED COOSE\nWASHINGTON\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nI.\nName of applicant in full Wazel Gertrude Brunor\n2. Address in full\nyst.\n2401 Sacromento St. San Francisco - Caly.\n3.\nDate of birth\naugust 7- 1891\nPlace of birth Santa Rosa. Caly\n4. Are you married, single or a widow?\nSingle\nAre you a citizen of the United States?\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nnone\nyes,\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nSanta were graduated Rosa Santa High Rosa S chool- Grammar graduated School and\n7. Occupation before entering training school none\n8. From what hospital training school did you receive your diploma? Give location of hospital and date of graduation\nfrom Lane Hap ital Training School - 1913\nSan Francisco - ealy onnia\n9.\nIf your training as a nurse was received in more than one hospital, give name, location and time spent in each\nIO.\nCharacter of hospital: General? yes\nSpecial?\nPrivate? -\nII. Did your training include the care of men? yes\nContagious diseases?\nno\nObstetrics? yes\n12. Daily average number of patients in hospital during training\n150\nLength of course\nsyre.\n13. Name and address of superintendent of training school under whom you received training\nmiss Harriet m= arthur - Presp. Hospital new York\n14. Of what nursing organizations are you a member?\nLand Hospital alumnian\n15. Which, if any, is affiliated with the American Nurses Association?\nLane Alumni\n16.\nGive name and address of secretary of at least one of these organizations. miss Klute , San mate\nCaly onnia Secretary Rane Clumni\n17. Are you a registered nurse? yes\nIn what state? Calif Date of registration 1914\n18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present\nemployment\nPrivate duty during I yrs.\n19. Should our country be involved in war, would you be available for active service? yes\n20. Would you be willing to take the oath of allegiance?\nyes\n21. What languages other than English do you speak?\nnone\n22. Name and permanent address of nearest relative mr. e.m Bruner. 421 Second St.\nDate march 16- 1917\nSanta Rosa Caly\nSignature Hazel g. Bruner.\nThis blank is to be sent to applicant with circular letter Form 7, together with Form 11, and rules governing enrollment. After\napproval and endorsement by local Committee to be forwarded with \"credentials\" (Forms Nos. 3 and 4) together with Forms 10-11 to the\nChairman, National Committee on Red Cross Nursing Service, Washington, D. C."
}