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2 D.M.R.-1 - NURSING SERVICE APPLICATION FOR ENROLLMENT (To be filled out entirely in applicant's handwriting) Earily Hanmored Smith alive see 1. Name of applicant in full 2. Address in full 661 n 179th. st herr Jack bity ny. 39 3. Date of birth February 4th 1878 Place of birth Beverly maccahueetts 4. Are you married, single or a widow? single 5. Have you any physical defects or tendency to constitutional or pulmonary trouble? Are you a citizen no of the United States? year Are you physically strong and healthy? yes 6. Name educational institutions attended before entering training school, stating number of years at each and from which you were graduated Public schools in Hamilton macs. Eyrs. Graduate from the Beverly stj school Bent mass 3yro. 7. O.K. 8. From what hospital training school did you receive your diploma? The l hildrens Hospital Occupation before entering training school Clerk , office assist to City and state Baston mass-to - Date of graduation november 9. Character of hospital: General? chiedreno twenty 1905 Special? Private? 10. Did your training include obstetrics? no Care of men?. yes 100 Children? yes Contagious diseases? 3 no 11. Daily average number of patients in hospital during training Length of course years 12. Name and address of superintendent of training school under whom you received training sister Pusanum present address. 1st mayauto. Louisbey Bg. Badan mass. 13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each 4 mouths mars. Basten mass. o.k 3 mas Carey This Private Hagp Brooklin mass. 14. Of what nursing organization are you a member? The b hiedreus' Hospital alumnar assore Baston 15. Which, if any, is affiliated with the American Nurses Association? The alemunae aesoin 16. name and at least one Give address of secretary of of these organizations. nurs nears Dorothy young The Childrens' Hospital Baston 17. Are you a registered nurse? In what state?. Bear york Date of registration. applied 30- angline 18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present Baston two years Kelept no show Babies Summer Hospital Reasons employment, giving name and address of persons in charge. Private nursing new your 2 Palem mars about 6 mas. Private nursing Jubuculasis Davana Lahe ny -Do Baldevin Thru years in Dr Mays office seattle hu D-a.H may Lumber Ex Beda Reattle Itan just left then niu han change of hardin Children Haspital Baston 20. Would you be willing to take the oath of allegiance? 19. Should country be involved in war, would you be available for active service? yes our 21. What languages other than English do you speak? you Han slight knowledge granch 22. as a 23. Name and permanent address of nearest relative. Mis. Daniel 6. Smith. Would you be interested in qualifying for Red Cross service public health nurse? not at-pricent 2310 E. 51 St. seattle hashing ton Date may. 18th 1917 Signature. Camily Hannword smith. This blank is to be sent to applicant with circular letter Form No. 7, together with Forms No. 2, 11, and A. R. C. 150. After approval and endorsement by Local Committee to be forwarded with credentials (Forms Nos. 3 and 4) to- gether with Forms 10-11 to the Chairman, National Committee on Nursing Service, American Red Cross, Washington, D. c. It is important that the papers of those interested in Red Cross Service as a public health nurse, be forwarded to Washington as soon as possible in order that assignment to positions under the Town and Country Nursing Service may be made without delay or the arrangements for special preparation necessary for such assignments. REQ. 17-544-April

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    "ocrText": "2\nD.M.R.-1\n-\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nEarily Hanmored Smith\nalive\nsee\n1. Name of applicant in full\n2.\nAddress\nin full 661 n 179th. st herr Jack bity ny.\n39\n3. Date of birth\nFebruary 4th 1878\nPlace\nof birth Beverly maccahueetts\n4.\nAre you married, single or a widow? single\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nAre you a citizen no of the United States? year\nAre you physically strong and healthy? yes\n6. Name educational institutions attended before entering training school, stating number of years at each and from which you\nwere\ngraduated Public schools in Hamilton macs. Eyrs.\nGraduate from the Beverly stj school Bent mass 3yro.\n7.\nO.K.\n8.\nFrom what hospital training school did you receive your diploma? The l hildrens Hospital\nOccupation before entering training school Clerk , office assist to\nCity and state Baston mass-to -\nDate of graduation november\n9. Character of hospital: General? chiedreno\ntwenty 1905\nSpecial?\nPrivate?\n10. Did your training include obstetrics? no\nCare of men?. yes\n100 Children? yes Contagious diseases? 3 no\n11. Daily average number of patients in hospital during training\nLength\nof\ncourse\nyears\n12.\nName and address of superintendent of training school under whom you received training sister Pusanum\npresent address. 1st mayauto. Louisbey Bg. Badan mass.\n13. If your training as a nurse was received in more than one hospital, give name, location and time spent in each 4\nmouths\nmars. Basten mass.\no.k\n3 mas Carey This Private Hagp Brooklin\nmass.\n14. Of what nursing organization are you a member?\nThe b hiedreus' Hospital alumnar assore Baston\n15. Which, if any, is affiliated with the American Nurses Association? The alemunae aesoin\n16. name and at least one\nGive address of secretary of of these organizations. nurs nears Dorothy young\nThe Childrens' Hospital Baston\n17.\nAre you a registered nurse? In what state?. Bear york Date of registration. applied 30-\nangline\n18. State how, where and for what period of time, in each instance, you have been employed since graduation, including present\nBaston two years Kelept no show Babies Summer Hospital Reasons\nemployment, giving name and address of persons in charge. Private nursing new your 2\nPalem mars about 6 mas. Private nursing Jubuculasis Davana\nLahe ny -Do Baldevin Thru years in Dr Mays office\nseattle hu D-a.H may Lumber Ex Beda Reattle Itan just\nleft then niu han change of hardin Children Haspital Baston\n20. Would you be willing to take the oath of allegiance?\n19. Should country be involved in war, would you be available for active service? yes\nour\n21.\nWhat languages other than English do you speak? you Han slight knowledge granch\n22. as a\n23. Name and permanent address of nearest relative. Mis. Daniel 6. Smith.\nWould you be interested in qualifying for Red Cross service public health nurse? not at-pricent\n2310 E. 51 St. seattle hashing ton\nDate may. 18th 1917\nSignature. Camily Hannword smith.\nThis blank is to be sent to applicant with circular letter Form No. 7, together with Forms No. 2, 11, and A. R. C.\n150. After approval and endorsement by Local Committee to be forwarded with credentials (Forms Nos. 3 and 4) to-\ngether with Forms 10-11 to the Chairman, National Committee on Nursing Service, American Red Cross, Washington,\nD. c. It is important that the papers of those interested in Red Cross Service as a public health nurse, be forwarded\nto Washington as soon as possible in order that assignment to positions under the Town and Country Nursing Service\nmay be made without delay or the arrangements for special preparation necessary for such assignments.\nREQ. 17-544-April"
}