Tusculum College Athletic Training Educational Program Clinical Education Affiliation Agreement

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Tusculum College

Athletic Training Educational Program Clinical Education Affiliation Agreement

This Agreement, made this ________ day of ______________________, 20______, by and between Tusculum College (hereinafter referred to as the INSTITUTION) and (hereinafter referred to as AFFILIATE) shall govern

the use of the AFFILIATE's facilities by the students enrolled in the INSTITUTION's Athletic Training Educational Program (hereinafter referred to as PROGRAM). The Agreement is based on policies outlined below and may be revised as necessary by mutual agreement between the INSTITUTION’s PROGRAM and the AFFILIATE.

The AFFILIATE is desirous of assisting the INSTITUTION in the development of a program for

individuals to earn a Bachelor’s degree in Athletic Training. The INSTITUTION recognizes the need for such a program to be established to meet the needs for the local and national community and in the interest of helping the medical community. The INSTITUTION and the PROGRAM are agreeable to establish such a program with the AFFILIATE’s assistance and participation which shall be limited to functions as set out herein. Therefore, in consideration of the mutual promises and covenants hereinafter set forth, it agreed by and between the INSTITUTION’s PROGRAM and AFFILIATE, the agreement as outlined below:

I. Introduction

A. The purpose of this agreement shall be to provide clinical education (e.g., learning) experiences to students enrolled in the educational PROGRAM of the INSTITUTION.

B. Consideration for this agreement shall consist of the mutual promises contained herein, the parties agreeing that monetary compensation shall neither be expected nor received by either party.

C. The clinical education experience shall be provided in the AFFILIATE’s facility, located at:


(hereinafter referred to as FACILITY).

D. The specific educational experiences (i.e., Competencies in Athletic Training) to be provided to students are enclosed with this document.

II. General Terms and Conditions

A. The terms and conditions of this agreement are pursuant to the above-stated purpose.


1. The agreement shall be in force and effect from ______________________ (date) and shall continue for a period of 2 years at which time both parties may renew, but may not exceed 5 years without signing a new agreement. Either party may terminate this agreement provided discussions and documentation have been completed.

2. Either party wishing to terminate the contract must give 60 days written notice to the other party. Such termination shall have no effect on students currently receiving clinical education experience.

3. This Agreement constitutes the entire agreement between the parties and supersedes all prior agreements, arrangements, and understanding relating to the subject matters hereof.

Any modification hereto shall be valid only if set forth in writing and signed by all parties hereto.

B. While enrolled in the clinical education experience at the FACILITY, students (and faculty), if applicable, will be subject to applicable policies of the INSTITUTION, PROGRAM, and the AFFILIATE. Each party will be responsible for enforcing all applicable policy including that of the other party.

C. Students shall be dismissed from participation in the clinical education experience only after the appropriate disciplinary policies and procedures of the INSTITUTION and PROGRAM have been followed; however, the AFFILIATE may immediately remove from the premises any student who poses an immediate threat or danger.


A. The AFFILIATE and INSTITUTION’s PROGRAM shall provide liaison personnel for regular meetings to assure systematic planning and the exchange of information regarding policy changes, problems, evaluation, and new developments.

B. The right is reserved to either party to formally ask to have included in the program of training and/or education any additional features that it may deem desirable. Both parties hereby agree to give reasonable consideration to any such requests.

C. The confidentiality of patient records and student records shall be maintained at all times.

D. The INSTITUTION’s PROGRAM shall provide an orientation to the clinical education program for all involved AFFILIATE personnel and students (required attendance). The AFFILIATE will be responsible for providing orientation to students and faculty, if applicable, as to the policies and procedures of the AFFILIATE. Such an orientation shall include, but not be limited to, cardiac arrest protocol, policies and procedures pertaining to the area of

assignment, to fire and safety, infection control, universal precautions, and effective teaching and learning methods. The AFFILIATE shall have the right to require additional orientation as deemed necessary.

E. The maximum number of students from the PROGRAM assigned to the AFFILIATE during any instructional period shall be established by mutual agreement, and determined by the FACILITY in order to provide a adequate, variable, and quality learning opportunities. The specific assignments will be governed by accreditation guidelines related to clinical ratios of clinical instructors and students.


F. Where areas of difference exist or occur in rules, regulations or questions of student, clinical or medical practices, the higher standard between the PROGRAM’s and AFFILIATE's rules, regulations or practices shall prevail and such conflict shall be immediately referred to the PROGRAM and AFFILIATE representatives for mutual resolution.

G. The INSTITUTION and AFFILIATE will have a meeting between their respective

representatives, twice a year, for the purpose of evaluating the INSTITUTION's PROGRAM, reviewing this Agreement, and thereupon advising the AFFILIATE and INSTITUTION to whether or not the same should be renewed.

H. The INSTITUTION, PROGRAM, and AFFILIATE shall agree to comply with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973, Executive Order 11,246 and the related regulations to each. Each party assures that it will not discriminate against any individual including, but not limited to, employees or applicants for employment and/or students because of race, religion, creed, color, sex, age, handicap, veteran status or national origin.

The parties also agree to take affirmative action to ensure that applicants are employed and that employees are treated during their employment without regard to their race, religion, creed, color, sex, handicap or national origin. Such action shall include, but not be limited to, the following: equipment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection available to employees and applicants for employment.

IV. INSTITUTION and PROGRAM Responsibilities

A. The INSTITUTION and PROGRAM shall warrant that each student assigned to care for patients is currently in good academic standing with a cumulative grade point average of not lower than 2.50 (4.0 scale).

B. The INSTITUTION and PROGRAM will assume responsibility for the health requirements (i.e., physical exam) of its students and faculty, if applicable.

C. The INSTITUTION will assume full academic and administrative responsibility for the planning and execution of the PROGRAM, including, but not limited to, selection of students, matriculation, promotion and graduation. However, the INSTITUTION’s PROGRAM representative shall confer with the AFFILIATE personnel in advance of the PROGRAM's planned schedule of student assignments to clinical education areas, including the dates of assignments, number of students assigned, and type of educational experience. This schedule will require the approval of the AFFILIATE administrator.

D. All students and INSTITUTION staff/faculty engaged in clinical practice will present proof of having received the Hepatitis B vaccine or have signed a declination statement/waiver.

Individual records shall be maintained by the INSTITUTION.

E. The PROGRAM will maintain all records and reports on its student's clinical education experiences and will provide the AFFILIATE the names of all students engaged in clinical education experiences.


F. The INSTITUTION’s PROGRAM will assume the responsibility for verifying that all clinical instructors have current national and/or state certification and/or licensure. Athletic training approved clinical instructors must be certified by the National Athletic Trainers' Association- Board of Certification (NATA-BOC). All national and state licensure/certification numbers must be on file with the INSTITUTION.

G. The INSTITUTION’s PROGRAM shall direct both students and clinical instructors to comply with the published policies and procedures of the PROGRAM and AFFILIATE, and ensure that both students and clinical instructors have received adequate information regarding hazardous communication and universal precautions prior to assignment to the AFFILIATE.

H. The INSTITUTION’s PROGRAM shall assume full administrative responsibility for the appropriate attire of its students when they are administering patient care, and in this regard, the uniform, or other dress, which said students shall wear shall be acceptable to the AFFILIATE, as well as the PROGRAM, and students shall be identified as athletic training students of the INSTITUTION.

I. The INSTITUTION’s PROGRAM shall assure that each student is covered by professional liability insurance of at least $500,000 per occurrence, at the student's expense. Furthermore, the INSTITUTION shall ensure personal and professional liability for faculty.

J. The INSTITUTION shall maintain state or national accreditation by the appropriate body.

K. The students of the INSTITUTION’s PROGRAM shall provide their own transportation to and from the AFFILIATE at said student's expense.

L. Students of the INSTITUTION’s PROGRAM shall not be allowed to participate in clinical practice in any department in the health agency without prior consent of the liaison person and/or director of the PROGRAM.

M. Students and faculty members of the INSTITUTION shall not be reimbursed for rendering services to patients during the course of the clinical education program governed by this agreement, but shall donate their services to the health agency for the privilege of learning.

V. AFFILIATE’s Responsibilities

A. The AFFILIATE is responsible for the quality of health care rendered to patients.

B. The AFFILIATE shall make its facilities and patient care situations available to the students of the INSTITUTION’S PROGRAM for the purpose of education and learning.

C. The AFFILIATE shall be responsible for and retain absolute control over the organization, administration, operation, and financing of its services.


D. The AFFILIATE will make available for student's experience the clinical means for providing patient care, including, but not limited to, necessary expendable equipment and supplies.

E. The number of students receiving clinical education experiences at the AFFILIATE will be determined by the AFFILIATE representative and approved by the Clinical Coordinator of the PROGRAM.

F. The AFFILIATE shall have the right to deny access to or request removal from its facilities any student or faculty (1) whose performance is unsatisfactory, (2) whose personal characteristics or disregard for AFFILIATE regulation, policies, or procedures interfere with his/her performance or AFFILIATE operation, or (3) whose academic record with the INSTITUTION does not meet professional and PROGRAM requirements. Any such removals must be followed as outlined in the PROGRAM’s "Clinical Manual" and the INSTITUTION’S catalog.

G. No reduction in staff (e.g., clinical instructors) shall be made by the AFFILIATE due to the presence of the PROGRAM’s students.

H. The AFFILIATE shall provide direct supervision and clinical instruction to the PROGRAM’s students that meet all accreditation standards.

I. The services or duties of all PROGRAM students in the AFFILIATE's facilities are for the purpose of obtaining clinical education and experience, and not performed in the furtherance of the business (i.e., workforce) of the AFFILIATE. The PROGRAM’s students should not work more than 30 hours per week without prior permission from the Clinical Coordinator of the PROGRAM.

J. There is no contract of hire, express or implied, or any employer-employee relationship between the AFFILIATE and any student or faculty involved in the PROGRAM.

K. The AFFILIATE shall provide the use of instructional and library resource materials as may be available. The students must get permission before taking any resources from the FACILITY.

L. Services such as parking space and cafeteria facilities shall be made available to the

PROGRAM’s students and faculty at the same prices charged to AFFILIATE employees and other patrons.

M. The INSTITUTION and PROGRAM shall be informed regarding additional education programs and changes in clinical facilities which may affect the PROGRAM. Where multiple educational programs exist, the AFFILIATE shall devise ways for coordination so that all programs may have maximum benefit of learning experiences.

N. The clinical instructor or approved clinical instructor from the AFFILIATE is responsible for evaluating each student he/she supervises a minimum of once per month. The student will also be responsible for evaluating his/her clinical instructors. The PROGRAM will provide these forms to the AFFILIATE.

VI. Miscellaneous Terms


A. Neither party shall be responsible for personal injury or property damage or loss except that resulting from its own negligence or the negligence of its employees or others for whom the party is legally responsible.

B. The delay or failure of performance by either party shall not constitute default under the terms of this agreement, nor shall it give rise to any claims against either party for damages. The sole remedy for breach of this agreement shall be immediate termination.

C. Both the PROGRAM and AFFILIATE shall be responsible for meeting on a regular basis (i.e., once per month) to discuss any concerns.

In witness whereof, the parties, through there authorized representatives, have affixed their signatures below.


_______________________________________ _______________________________________

Clinical Coordinator, Facility Supervisor/ Clinical Instructor Athletic Training Educational Program (e.g. MD, ATC, PT, etc…)

_______________________________________ _______________________________________

Director, School of Education Director or Principal of the Affiliate Setting Tusculum College

______________________ ______________________

Date Date





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