AFFILIATION AGREEMENT BETWEEN NORTHERN ARIZONA UNIVERSITY AND MARICOPA COUNTY.PDF

AGREEMENT FOR CLINICAL PRACTICUM AND/OR EXTERNSHIP/ INTERNSHIP EDUCATION 
(“Agreement”) 
 
This Agreement is entered into by and between Arizona Board of Regents for and on behalf of 
Northern Arizona University principally located in Flagstaff, AZ (“University”) and Maricopa County 
Correctional Health Services (“Facility”) principally located in Phoenix, AZ. 
 
This Agreement will be in effect for five years unless a lesser time-period is stated herein. The 
effective date of this Agreement will be 7/1/2023 and will end on 6/30/2028 and may be renewed, 
revised, or modified by a written addendum signed by both parties. The parties agree that either party 
may terminate this Agreement at any time upon 30 days written notice, which may include electronic mail 
with delivery receipt, to the other party, except that any student already assigned to and accepted by the 
Facility shall be allowed to complete any in-progress clinical practicum and/or externship/internship 
education at the Facility (if feasible), provided, however, the parties retain the right to dismiss or withdraw 
any student pursuant to Section II. E. or Section III. F. 
 
The purpose of this Agreement is to establish a relationship between the University and the 
Facility, to allow students from the University to participate in a clinical practicum and/or 
externship/internship education approved by the University and conducted at the Facility’s sites. 
 
It is agreed by the parties to be of mutual interest and advantage for selected students at the 
University to be provided quality clinical practicum and/or externship/internship education experiences 
at the Facility. 
 
I. 
MUTUAL RESPONSIBILITIES 
 
A. 
University and Facility shall each designate a Clinical Education Coordinator (“CEC”) to be 
the designated representative to the other party for implementation of this Agreement 
and agree to notify the other party within 14 days of any change in its designated 
representative. 
 
B. 
The number of students assigned to the Facility and the dates of rotation shall be mutually 
agreed upon and shall be subject to the availability of the Facility’s personnel for teaching 
and supervision. The objectives, nature, and timeframe of the experiences shall be 
individually arranged and approved by the CECs for the Facility and the University. 
 
C. 
If Facility is a Covered Entity under the Health Insurance Portability and Accountability Act 
(“HIPAA”) of 1996, as amended by the American Recovery and Reinvestment Act of 2009 
(“ARRA”) each as amended from time to time, then students shall function as part of the 
Facility’s “workforce” as defined in 45 CFR §160.103 and shall be subject to the HIPAA 
policies and procedures of the Facility. Facility shall be responsible for providing the 
assigned students with the appropriate training in its HIPAA policies and procedures. 
University shall ensure that the assigned students are familiar with HIPAA prior to the 
assignment to the Facility. University and Facility shall advise the students to protect the 
confidentiality of protected health information or other confidential information 
pertaining to all patient/client/customer information (including medical records, 
electronic data, radiology films, laboratory blocks, slides and billing information), and 
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comply with all of Facility’s policies on the release of patient/client/customer information 
and all applicable federal and state laws and regulations protecting the confidentiality of 
patients’/clients’/customers’ records. 
 
D. 
Except as previously set forth, no provision of this Agreement shall be deemed to 
constitute University, or any agent or employee of University, as an agent or employee of 
Facility. Neither University nor Facility personnel, by virtue of this Agreement, are entitled 
or eligible by reason of the contractual relationship hereby created, to participate in any 
benefits or privileges given or extended by either party to its employees. The University 
and Facility do not consider a student an employee of the Facility or University for 
workers’ compensation purposes, but solely as a student in the clinical practicum and/or 
externship/internship education phase of the student’s educational and professional 
development. 
 
E. 
The parties agree to comply with all applicable state and federal laws, rules, regulations, 
and executive orders governing equal employment opportunity, immigration, 
nondiscrimination, including the Americans with Disabilities Act, and affirmative action. 
 
F. 
The policies, rules, and regulations of the Facility shall be applicable to the students. 
Facility shall inform students of its policies, rules, and regulations at the initiation of the 
clinical practicum and/or externship/internship education. University shall inform its 
students of their responsibility to comply with the laws, as well as the policies, rules, and 
regulations of Facility. 
 
G. 
Neither the Facility nor the University shall use the name of the other party or its 
employees in any publicity or advertising material without prior written approval by a 
duly authorized representative of the other party. 
 
II. 
UNIVERSITY RESPONSIBILITIES 
The University shall: 
 
A. 
Give Facility at least 30 days’ notice of a student assignment unless this notice is 
specifically waived by the Facility by agreeing to this at less than 30 days. Reserve the right 
to revoke any assignment prior to a student’s entry into the clinical practicum and/or 
externship/internship education at the Facility. 
 
B. 
Forward to the Facility a summary of the student’s training and experience which shall 
include but is not limited to information on the student’s general education and academic 
standing. 
 
C. 
Contact or visit the Facility for the purpose of monitoring student progress and 
performance and facilitating information exchange between the University, Facility, and 
the student. 
 
D. 
Reserve the right to dismiss or withdraw any student from assigned clinical practicum 
and/or externship/internship education at the Facility when, in the University’s CEC’s 
judgment, the clinical practicum and/or externship/internship education no longer meets 
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the needs of the student. 
 
E. 
Provide Facility with a statement of expectations and objectives of curricular and clinical 
education, upon request. 
 
F. 
Ensure that students review and understand their responsibilities under this Agreement 
as outlined in Appendix A. 
 
G. 
If requested by Facility prior to placement of any student, the University’s CEC shall verify that 
the student has (i) successfully passed a criminal background check; and (ii) meet all 
immunization requirements of the Facility. 
 
III. 
FACILITY RESPONSIBILITIES 
The Facility shall: 
 
A. 
Provide clinical practicum and/or externship/internship education experiences as stated 
in the objectives of the University and Facility and provide supervision appropriate to the 
academic and clinical level of the assigned student. 
 
B. 
Provide appropriate orientation and information regarding the policies, rules, and 
regulations of the Facility to incoming students. 
 
C. 
Make available the physical facilities and other equipment necessary to support the 
clinical practicum and/or externship/internship education. 
 
D. 
Retain primary responsibility for its patients/clients/customers. 
 
E. 
Complete forms requested by the University, such as but not limited to general 
information form or student evaluation report. 
 
F. 
Request the University to dismiss or withdraw a student from assigned clinical practicum 
and/or externship/internship education when the student’s performance is 
unsatisfactory or the student’s behavior is disruptive or detrimental to the Facility and/or 
violates the Code of Ethics of the discipline, or Facility regulations, policies, or procedures. 
 
G. 
Provide and/or facilitate emergency care for students if needed, and the student intern 
shall be responsible for the cost of said emergency care. 
 
H. 
Acknowledge the risk of the spread of COVID-19 in the workplace and implement 
enhanced health and safety measures, in accordance with guidelines from the U.S. 
Centers for Disease Control and Prevention, and of other regulatory institutions, in 
response to the COVID-19 pandemic. The Facility shall ensure that such health and safety 
measures are afforded to, and provided for, all students assigned to the Facility. 
 
 
IV. 
INSURANCE 
 
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University is an Arizona public institution of higher education and is self-insured through the 
Arizona Department of Administration Risk Management Division pursuant to Arizona Revised 
Statutes (“A.R.S.”) §41-621, et seq. University shall maintain adequate insurance to cover any 
liability arising from the acts and omissions of University students, employees or agents 
participating in the program. University shall not be responsible for maintaining insurance 
coverage for liability arising from the acts and omissions of Facility employees or agents. 
Facility shall maintain adequate insurance (which may include a bona fide self-insurance 
program) to cover any liability arising from the acts and omissions of Facility employees or 
agents. Facility shall not be responsible for maintaining insurance coverage for liability arising 
from the acts and omissions of University students, employees or agents. 
 
V. 
WORKERS' COMPENSATION 
 
Workers' Compensation insurance to cover obligations imposed by Federal and state 
statutes having jurisdiction of University's employees engaged in the performance of the 
work or services under this Agreement; and Employer's Liability insurance of not less than 
$1,000,000 for each accident, $1,000,000 disease for each employee, and $1,000,000 
disease policy limit. 
 
VI. 
PROFESSIONAL LIABILITY INSURANCE 
 
University shall provide professional liability through the Arizona Department of Administration 
Risk Management Division to cover liabilities arising from the acts and omissions of the 
University’s employees and students participating in this Agreement. If requested, upon full 
execution of this Agreement, a self-insurance letter or certificate of insurance will be furnished 
to the Facility indicating the effective coverage. 
 
 
VII. 
CERTIFICATES OF INSURANCE 
 
A. 
Clinical rotations will not begin until University has provided proof of insurance. 
 
B. 
Prior to the start of clinical rotations, University shall furnish Facility with valid and 
complete certificates of insurance as required by the Agreement. 
 
C. 
In the event any insurance policy(ies) required by this Agreement is (are) written on a 
claims-made basis, coverage shall extend for two years past completion and 
acceptance of University's work or services and as evidenced by annual Certificates 
of insurance. 
 
D. 
If a policy does expire during the life of the Agreement, a renewal certificate must be 
sent to County 15 calendar days prior to the expiration date. 
 
 
VIII. 
CANCELLATION AND EXPIRATION NOTICE 
 
Applicable to all insurance policies required within the insurance requirements of this 
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Agreement, University's insurance shall not be permitted to expire, be suspended, be 
canceled, or be materially changed for any reason without 30 calendar days prior written 
notice to Maricopa County. University must provide notice to Maricopa County, within two 
business days of receipt, if they receive notice of a policy that has been or will be suspended, 
canceled, materially changed for any reason, has expired, or will be expiring. Such notice 
shall be sent directly to Maricopa County Office of Procurement Services and shall be mailed, 
or hand delivered to 301 W. Jefferson St. Suite 700, Phoenix, AZ 85003, or emailed to the 
procurement officer noted in the solicitation. 
 
I X . 
INDEMNIFICATION FOR ARIZONA PUBLIC ENTITIES  
 
Each party (as “indemnitor”) agrees to indemnify, defend, and hold harmless the other party 
(as “indemnitee”) from and against any and all claims, losses, liability, costs, or expenses 
(including reasonable attorney’s fees) (hereinafter collectively referred to as “claims”) 
arising out of bodily injury of any person (including death) or property damage but only to 
the extent that such claims which result in vicarious/derivative liability to the indemnitee, 
are caused by the act, omission, negligence, misconduct, or other fault of the indemnitor, 
indemnitor's officer, officials, agents, employees, or volunteers. 
 
X. 
MISCELLANEOUS 
 
A. 
Any notice required or permitted hereunder shall be in writing and shall be deemed given 
if delivered in person, electronic mail with delivery receipt, or three days after mailing, by 
United States registered or certified mail, postage prepaid, and addressed as follows: 
 
To Facility: 
 
Maricopa County Correctional Health Services  
Attention: Donna Campbell 
3250 West Lower Buckeye Road 
Phoenix, AZ 85009 
Phone: 602-876-7115 
Email: chsunpaidlearningexperience@maricopa.gov  
 
To University: 
 
College of Health and Human Services Office of the Dean 
P.O. Box 15015 
Flagstaff, AZ 86011 
Phone: 928-523-4331 
Email: CHHS@nau.edu  
 
 
With a copy to:
 
Northern Arizona University Contracts, Purchasing and Risk Management  
PO Box 4124 
Flagstaff, AZ 86011 
Phone: 928-523-4557 
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Email: NAU-Contracts@nau.edu   
 
B. 
All books, accounts, reports, files, and other records relating to this Agreement shall be 
subject at all reasonable times to inspection and audit by either party, or the Auditor 
General of the State of Arizona, or their agents for five years after the completion of this 
Agreement. Such records shall be provided upon reasonable notice to the other party.  
 
C. 
The parties agree that this Agreement may be cancelled for conflict of interest in 
accordance with A.R.S. §38-511. Facility and University certify that no such conflict of 
interest currently exists and that there are no relevant facts or circumstances which could 
give rise to any actual or potential organizational or personal conflicts of interest. 
 
D. 
Pursuant to A.R.S. §12-1518, the parties acknowledge and agree that both parties may be 
required to make use of mandatory arbitration of any legal action that is filed in the 
Arizona Superior Court concerning a controversy arising out of this Agreement if required 
by A.R.S. §12-133. 
 
E. 
Student educational records are protected by the U.S. Family Educational Rights and 
Privacy Act, 20 U.S.C. § 1232g and its implementing regulations (“FERPA”). Facility will not 
require any University students or employees to waive any privacy rights (including FERPA 
or the European Union’s General Data Protection Regulation (“GDPR”)) as a condition for 
receipt of any educational services, and any attempt to do so will be void. Facility will comply 
with FERPA and will not access or make any disclosures of student educational records to 
third parties without prior notice to and consent from the student or as otherwise 
provided by law. If this Agreement requires or permits Facility to access or release any 
student records, then, for the purposes of this Agreement only, the University designates 
Facility as a “school official” for the University under FERPA, as that term is used in FERPA. 
 
F. 
Except as otherwise agreed in writing, the parties acknowledge that the relationship 
created by this Agreement is limited to the student clinical practicum and/or 
externship/internship education contemplated herein. Neither party shall make any 
representations stating or implying that the parties engage in broader transactions or that 
a party is otherwise associated with the other party without first obtaining express written 
permission from the other party. In addition, neither party shall use any trade name, 
trademark, service mark, logo, domain name, nor any other distinctive brand feature 
owned or used by the other party without prior written authorization from the other party. 
 
G. 
The parties acknowledges that each is a public entity subject to the provisions of the Arizona 
Public Record Laws A.R.S. §§ 39-121, et seq. 
 
H. 
If either party's performance under this Agreement depends upon the appropriation of 
funds by the Arizona Legislature, and if the Legislature fails to appropriate the funds 
necessary for performance, then that party may provide written notice of this to the other 
and cancel this Agreement without further obligation. Appropriation is a legislative act and 
is beyond the control of either party. 
 
I. 
Neither party shall be held responsible for any losses resulting if the fulfillment of any 
terms or provisions of this Agreement are delayed or prevented by any cause not within 
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the control of the party whose performance is interfered with, and which by the exercise 
of reasonable diligence, said party is unable to prevent (“force majeure event”), including 
but not limited to acts of God, war, civil disturbance, terrorism, disaster, fire, earthquakes, 
hurricanes, known or suspected threats of illness, epidemics, pandemics, or government 
regulation. This Agreement may be terminated without further obligation or penalty, 
including cancellation fees or liquidated damages, of either party upon written notice 
from the affected party to the other party of such force majeure event. 
 
J. 
Each party to this Agreement shall be responsible for each party’s own costs for 
performance of its respective obligations pursuant to this Agreement.  
 
K. 
In the event that any provision or part of any provision of this Agreement shall be 
determined by a court of competent jurisdiction to be invalid or unenforceable, such 
determination shall not affect the remaining parts or provisions of this Agreement which 
shall continue in full force and effect. 
 
L. 
This Agreement constitutes the entire agreement and understanding of the parties with 
respect to its subject matter. No prior or contemporaneous agreement or understanding 
will be effective. This Agreement may not be modified or amended except by written 
instrument signed by both parties. This Agreement and all claims arising out of or relating 
to this Agreement shall be governed exclusively by the laws of the State of Arizona, the 
courts of which shall have jurisdiction over its subject matter. 
 
M. 
This Agreement may be executed in counterparts, each of which will be deemed to be an 
original but all of which, taken together, shall constitute one and the same agreement. 
The exchange of copies of this Agreement and of signature pages by electronic means 
shall constitute effective execution and delivery of this Agreement as to the parties and 
may be used in lieu of the original Agreement for all purposes. Signatures of the parties 
transmitted by electronic means shall be deemed to be their original signatures for all 
purposes. 
 
N. 
Neither party shall assign this Agreement without the prior written consent of the other 
party.  
 
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective dates 
written below. 
 
ARIZONA BOARD OF REGENTS  
 
MARICOPA COUNTY 
FOR AND ON BEHALF OF 
 
BOARD OF SUPERVISORS 
 
 
 
NORTHERN ARIZONA UNIVERSITY  
 
 
 
 
By: 
 
 
 
 
 
 
By:  
 
 
 
 
 
 
Name: Karen Pugliesi, PhD 
 
 
 
Name:  
 
 
 
 
 
Title: Executive Vice President and   
 
Title: Chairman, Board of Supervisors  
 University Provost 
 
Date:   
 
 
 
 
 
Date:   
 
 
 
 
 
 
 
 
 
                                                 
ATTEST: 
 
 
 
                                                            
By:   
 
 
 
 
 
 
 
                                                             
Name: _____________________________       
                                                                                     
Title:  Clerk of the Board  
 
 
 
                                                 
Date:   
 
 
 
 
 
 
 
APPROVED AS TO FORM: 
 
 
 
 
 
 
 
By:  
 
 
 
 
 
 
 
 
 
 
 
 
 
Name:  
 
 
 
 
 
 
 
 
 
 
 
 
Title: Deputy County Attorney 
 
 
 
 
 
 
 
Date:   
 
 
 
 
 
 
 
 
 
 
6/21/23
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Davina Bressler
6/23/2023

APPENDIX A: STUDENT RESPONSIBILITY STATEMENT 
This acknowledgment is made by the student identified below to acknowledge certain duties and 
responsibilities with regard to participation in a clinical practicum and/or externship/internship education 
experience in the Arizona Board of Regents for and on behalf of Northern Arizona University 
(“University”) program at the location where the clinical practicum and/or externship/internship 
education experience takes place (“Facility”). 
DUTIES AND RESPONSIBILITIES OF STUDENT 
1. The student will complete and be responsible for the cost of providing all health forms, health 
insurance, and certificates requested by the Facility. 
2. The student will comply with all applicable policies, procedures, and rules of the Facility. 
3. The student will participate in orientation, required mandatory education, and skill training as 
required by the Facility. 
4. The student will demonstrate professional behavior appropriate to the environment, including 
adhering to 
Facility’s established dress code and maintaining high standards of 
patient/client/customer care at all times. 
5. The student will follow the policies, rules, and regulations of Facility, including those regarding 
confidentiality of protected health information or other confidential information pertaining to 
patient/client/customer records. 
6. The student’s conduct at all times, both at the Facility and outside normal business hours, will be 
in a personally and professionally ethical manner. 
7. The student will make appropriate arrangements for transportation and housing, if necessary, 
and be responsible for all travel and living expenses incurred in relation to the clinical practicum 
and/or externship/internship education experience. 
8. The student understands and agrees that participation will be as a student and shall not be 
considered an employee of Facility or University for any purpose and will receive no compensation 
or employee benefits. 
9. The student agrees that University may share information received from the student's Criminal 
Background Check and Drug Testing with Facility, if applicable. 
10. The student will conform to the work schedule of Facility and make up time and work missed 
during unavoidable illnesses, in consultation with Facility supervisor and student’s University 
placement coordinator, clinical education coordinator, or clinical instructor. 
11. The student will obtain prior written approval from University and Facility before publishing or 
presenting any material relating to the clinical practicum and/or externship/internship education 
experience outside the normal educational settings of the University. 
12. The student acknowledges the inherent risk of exposure to COVID-19 which exists in any public 
place where people are present. COVID-19 is an extremely contagious disease that can lead to 
severe illness and death. By participating in the program, the student assumes all risks related to 
exposure to COVID-19. 
I HAVE READ AND UNDERSTAND THIS ACKNOWLEDGMENT AND AGREE TO ABIDE BY ITS TERMS AND CONDITIONS: 
 
Student Name:           
 
 
 
(Please type or print) 
 
Student Signature 
Date 
 
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