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1 Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS 102 NURSING SERVICE 102 Name in full Storey Marjory Tel. No (last) (first) (middle) If married, give maiden name Year of birth 1898 Marital status Single Husband's name (single, married, widowed, divorced) Permanent address 30Hortenss St. Rochester Monroe n.4. (street) Probable address (city) (county) (state) for the next year 411 W. 116th st. newYorkCity 3months (street) (city) n.4. (county) (state) Give name and address of nearest relative or friend in United States: mrs. games spining Sister (name) 568 Wellington aw Rochester, n.y. (relationship) (address) Are you employed in nursing at the present time? Yes qen.2216g No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health Visiting nursi Assn Rochestri, n.4. Industrial Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching of present employment Private duty Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? Less than One Two Three Four one year Bachelor's Master's year years P.H.D. years years Certificate in degree degree degree Public Health In what major field was above study? History x Economics What languages, other than English, do you speak? - *Academic year (OVER)

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    "ocrText": "1\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\n102\nNURSING SERVICE\n102\nName in full\nStorey\nMarjory\nTel. No\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth\n1898\nMarital status\nSingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 30Hortenss St.\nRochester\nMonroe\nn.4.\n(street)\nProbable address\n(city)\n(county)\n(state)\nfor the next year\n411 W. 116th st.\nnewYorkCity\n3months\n(street)\n(city)\nn.4.\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nmrs. games spining\nSister\n(name)\n568 Wellington aw Rochester, n.y.\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nqen.2216g\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nVisiting nursi Assn Rochestri, n.4.\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nof present employment\nPrivate duty\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\none year\nBachelor's\nMaster's\nyear\nyears\nP.H.D.\nyears\nyears\nCertificate in\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study? History x Economics\nWhat languages, other than English, do you speak?\n-\n*Academic year\n(OVER)"
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