J. Henry Cochran, President.
Dr. Louis Schneider, Secretary.
A. Niemeyer, Treasurer.
Williamsport Hospital
Williamsport, Penn'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.
Send photograph
Application for Admission to the Training School for Nurses.
1. Name? Martha M. Lay
2. Address? 330 E. Church St. Lock Haven, Pa.
3. Date and place of birth? Dec. 7. 1877, Centre, Perry Co., Pa.
4. Height? 5 ft. 6 in. Weight? 150 lbs.
5. Present occupation, if any?
6. Married? ; Single? Yes ; Widow?
7. If Widow, how many children? / their ages?
How provided for?
8. Are you in good health at present? I am
9. Have you good vision? I have; Hearing? I have
10. Have you any tendency to Consumption? No
11. Where were you educated? At Lock Haven
12. Have you ever been in a Hospital in any capacity? If so, where and when'?
I have not
13. To what church do you belong? Trinity M.E. Church.
14. Give the names and addresses of two persons who can recommend you. (One may
be that of your last employer) Mr. Marvin Elleston & Mr. Geo. W. Mason [Lock Haven, Pa.]
Sept. 10, 1899
Signed Martha M. Lay
Lycoming County Women's History Collection
