J. Henry Cochran, President.
Dr. Louis Schneider, Secretary.
A. Niemeyer, Treasurer.
'Williamsport, TPenn'a.
This is to be filled out in the Candidate's ozvn handwriting, and sent to Miss Virginia Loomis, Superintendent of the Williamsport Training School for Nurses.
A letter from a clergyman or teacher, relating to the moral character of the applicant, and a certificate of
good health from a physician, must accompany this application.
The physician must make a thorough physical examination of the candidate before issuing the certificate.
Application for Admission to the Training School for Nurses.
1. Name?
2. Address ?
j: Date and place of birth
4. Height?Spt &2vL. / Weight? .
5. Present occupation, if any? *
6. Married? ; Single? QU&^dA; Widow?
7. If Widow, how many children? ; their ages?.
How provided for?
8. Are you in good health at present?
9. Have you good vision ; Hearing?
10. Have you any tendency to Consumption?\
11. Where were you educated?(
12. Have you ever been in a Hospital in any capacity? If so, where and wlMi?
ij. To what church do you belong?
14. Give the names and addresses of two persons who can recommend you. {One may
'ie thatff your last employer.
Signed,
Lycoming County Women's History Collection
