BENEDICTINE AFFILIATION AGMT.PDF

Benedictine University
INTERNSHIP AFFILIATION AGREEMENT
This Internship Affiliation Agreement is made by and between Maricopa County, by and for its Department of Public
Health, (whose principal office is located at 4041 N. Central Ave., Ste. 1400, Phoenix, AZ 85012, (the "Internship Site"),
and Benedictine University, an Illinois not-for-profit corporation located in Lisle, Illinois (the "University").
WHEREAS, the University is currently conducting a program granting the degree of Master of Public Health (MPH), and
the University desires to obtain the assistance of the Internship Site in furthering its educational objectives and
specifically in developing and implementing the internship phase of the curriculum for such degrees; and
WHEREAS, the Internship Site provides capability for learning experiences and is interested in providing assistance to the
University in its curriculum, and the Internship Site further is interested in utilizing the services of the University's
students in an internship phase of the curriculum for such degrees offered by the University; and
WHEREAS, the parties hereto agree that for the mutual benefit of each as independent contractors and not as partners
or joint venturers, a formal affiliation should be entered into, and to set forth in this Agreement the terms and
conditions governing their affiliation and the internship for the University's above-referenced degree at the Internship
Site (the "Internship Program").
NOW, THEREFORE, in consideration of these premises and for other good and valuable consideration, the sufficiency of
which is acknowledged, the parties hereby agree as follows.
AGREEMENT
1. Purposes: The purposes of the Internship Program are:
A. to improve the students' understanding of the application and practicality of the theory and principles of the
discipline in which they are seeking a degree;
B. to foster development and deeper understanding of such discipline by exposure to new topics and
experiences in a non-classroom atmosphere;
C. to expose the student to the realities of an employer-employee relationship within the discipline and thus to
prepare the student for a more effective transition to employment in the field; and
D. To give the student actual experience in the discipline.
2. Duties and Responsibilities of the Internshlp Site. The duties and responsibilities of the Internship Site shall be as
follows. The Internship Site:
A. Shall have sole authority and responsibility for resident and/or client care and service, and adherence to
quality standards at the Internship Site and in all programs and services provided to residents or clients at the
Internship Site.
B. Agrees that the students participating in the Internship Program will have the status of students, that the
Internship Site shall not consider, utilize or assign such students to be replacements for the Internship Site's
staff, and that such students will not render care and/or service to the residents and/or clients of the
Internship Site except as such care and service are identified for educational value and delineated in the joint
planned educational program of the Internship Program. Any such direct contact between a student and a
patient or client of the Internship Site shall be under the proximate supervision of a member of the staff of
Benedictine University internship Affiliation Agreement 07.09.14

the Internship Site, which shall at all times remain responsible for patient and/or client care.
C. Shall assign each student to a designated individual affiliated with the Internship Site who shall orient the
student with respect to the rules, procedures, policies and practices of the Internship Site, including but not
limited to its policies prohibiting harassment and the complaint procedures for reporting any such
harassment. The students shall be individually responsible for their compliance with all applicable rules,
procedures, policies and practices of the Internship Site in connection with their participation in the
Internship Program, including without limitation, while the students are in attendance at the Internship Site.
D, Shall provide the facilities, experiences and personnel necessary to meet the University's standards for the
provision of internship education, and shall provide the students with appropriate instructions and work
assignments for the purpose of assisting in the proper development of the student's knowledge and skills.
E. Shall designate at least one individual affiliated with the Internship Site who shall serve as the Preceptor for
the Internship Program. Such individual will have met the academic and other standards required by the
parties.
F. Shall determine the number of students and term of the Internship Program experience based on the needs
of the Internship Site and the University, and taking the space available into account (it being understood
that the Internship Site shall make the final decision as to the number of students it can accommodate).
G. Has sole authority to discontinue the Internship Program or reduce the number of students (with adequate
advance notice to the University), if the Internship Site determines that the Internship Program is interfering
with the delivery of resident or client care and/or services, or that a problem exists involving the students
and/or University faculty member which cannot be resolved. In the event the census or use of the services
provided by the Internship Site decreases, the Internship Site has sole authority to reduce the number of
students in the Internship Program proportionally (with adequate advance notice to the University),
H. Shall submit to the University instructor or liaison an evaluation of each student's progress based on his or
her performance in the Internship Program, and shall otherwise cooperate in the University's formal
evaluation of the students consistent with the educational objectives and procedures mutually discussed and
agreed by the parties.
I. Shall ensure that all records relating to a student's performance in the Internship Program shall be made
available to the parties hereto, and the student, and not to other persons, as required by the Family
Educational Rights and Privacy Act of 1974 and the regulations promulgated thereunder (as amended).
J. By entering into this Agreement, the parties hereto do not intend that any of the University's staff or any
student participating in the Internship Program is to be an employee of the Internship Site for any purpose,
except that to the extent that the activities performed hereunder are subject to the provisions of the
Healthcare Information Portability and Accountability Act of 1996 (HIPAA"), the student shall be deemed a
member of the Internship Site's workforce at all times while performing the Internship Program duties and
activities. The University's staff and students shall not act as the Internship Site's agents or representatives
in any capacity, and shall not make any commitments on behalf of the internship Site. The parties to this
Agreement are not partners, agents nor principals of one another.
K. Emergency treatment of students. In case of an accident or illness emergency at the Internship Site,
standard procedure will be followed. It is the student's responsibility to bear the cost of the emergency
treatment.
3. Duties and Responsibilities of the University. The duties and responsibilities of the University shall be as follows.
The University shall:
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A. Assign students to participate in the Internship Program. The number of students assigned and the dates of
their assignment shall be mutually agreed upon by the Internship Site and the University, in writing.
B. Send to the Internship Site for participation in the Internship Program only such students as the University
believes are able to undertake the physical requirements of Internship Program.
C. Furnish any needed data and information about internship candidates which the University is authorized to
release.
D. Designate and provide an instructor or liaison (the Internship Coordinator) to assume overall responsibility
for the students' learning experience and who will be responsible for assignment of grades. The parties
acknowledge and agree that such Internship Coordinator may also be affiliated with the Internship Site as its
representative for the Internship Program.
E. Notify the Internship Site of any change in student status.
F. Withdraw from the Internship Program, upon recommendation, any student who fails to meet the standards
for participation in the internship Program that the parties have mutually agreed upon.
G. Provide to the Internship Site student evaluation information, including a format for evaluating students
during the Internship Program.
H. Award academic credit for completion of the Internship Program (or any designated component thereof that
is eligible for award of academic credit) as set forth in the applicable University catalog and in accordance
with applicable University rules, policies and procedures.
Pay for any equipment damaged or destroyed by students or faculty, other than through normal use,
according to an established procedure for verification.
J. Advise all students assigned to or making use of any clinical area of the Internship Site that they must adhere
to appropriate rules, procedures, policies and practices, including fulfilling the health status requirements, of
the Internship Site during the term of their assignment. The Internship Site will inform the students of its
immunization requirements (if any). Participating students will furnish to the Internship Site, at the
commencement of their participation in the Internship Program, verification of compliance with such health
requirements.
K. Inform participating students that they are required to carry their own personal health insurance.
L. Maintain (for the University) comprehensive general liability insurance (for students and faculty) at levels
required by law, but not less than One Million Dollars ($1,000,000) per occurrence and Three Million Dollars
($3,000,000) in the aggregate, and student professional liability insurance with limits of at least One Million
Dollars ($1,000,000.00) per occurrence and Three Million Dollars ($3,000,000.00) aggregate. A copy of a
certificate of insurance for such student professional liability insurance will be made available to the
Internship Site upon request. The University will deliver to the Internship Site thirty (30) calendar days' prior
written notice of any expiration or cancellation of such coverage. In the event of insufficient coverage the
Internship Site reserves the right to terminate this Agreement.
M. Agree that the faculty members and students enrolled at the Internship Site shall not be employees or agents
of the Internship Site or Maricopa County, and shall not be entitled to any defense or indemnity under
Maricopa County's Declaration of Trust for Maricopa County, Arizona, Self-Insured Risk Trust Fund, stipends,
benefits, conditions, terms or rights of Internship Site employees including worker's compensation, medical
Benedictine University Internship Affiliation Agreement 07.09.14

or hospitalization insurance or benefits, pension, retirement or vacation pay, credit or other benefits or rights
of Internship Site employees. Internship Site employees employed by the University as faculty members on
their own time (non-Internship Site pay status) will be subject to the same restrictions as stated herein.
N. Evidence of student certifications, vaccinations, etc. Where applicable, the University shall provide evidence
that student has met all requirements with respect to hepatitis B vaccination, and OSHA compliance for
prevention of transmission of blood borne pathogens and TB.
O. Criminal background check and drug screen compliance. Where applicable, a criminal background check and
drug screen, required by and acceptable to the Internship Site, are required of each placed student prior to
participation in the clinical rotation. It is the University's responsibility to ensure that the background check
and drug screening have been completed and that students with unacceptable results will not participate, if
the Internship Site has informed the University in writing that students with such results are precluded from
participation by policy.
P. University notices to students. The University shall notify each student prior to his/her arrival at the
Internship Site that he or she is required to:
(1) Follow the administrative policies, standards, and practices of the Internship Site.
(2) Obtain medical care at his or her own expense for any injuries or illnesses sustained as a direct or
indirect result of his/her affiliation with the Internship site.
(3) Provide his or her own transportation.
(4) Report to the Internship Site on time and follow all established regulations during the regularly
scheduled operating hours of the Internship Site.
(5) Conform to the standards and practices established by the University while functioning at the
Internship Site.
(6) Obtain prior written approval of the Internship Site and the University before publishing any
material relating to the clinical learning experience.
(7) Meet the personal, ethical, and professional standards required of employees of the Internship Site
and consistent with the applicable professional Code of Ethics and the applicable standards of KANO
and/or other relevant accrediting or regulatory bodies.
4. Mutual Duties and Responsibilities. During the term of this Agreement, and with respect to the Internship
Program or Programs under this Agreement, the Internship Site and the University mutually agree as follows:
A. That at no time shall they discriminate on the basis of any legally protected group, status or characteristic,
including but not limited to race, creed, color, religion, national origin, age, sex, disability or handicap,
veteran or military service status, sexual orientation or gender identity, or marital status, as to employees,
students, or service population.
B. That neither shall be compensated by the other as a result of this affiliation.
C. That the University's representative and the Internship Site counterpart representative shall cooperate in
good faith in working out the details of the implementation of this Agreement, and such representatives shall
meet and confer (or communicate by other mutually agreeable means) each year prior to the expiration of
the term thereof, for the purpose of planning and evaluation with respect to the Internship Program.
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D. That they agree generally to respect in good faith the need to maintain the privacy of personally identifiable
patient information that may come to the attention of their respective employees and students during the
term of this Agreement. The confidentiality of treatment records and other information concerning patients
will be maintained in accordance with applicable state and federal statutes and regulations, including the
Standards for Privacy of Individually Identifiable Health Information as required under the Health Insurance
Portability and Accountability Act. The parties will notify one another if there are known breaches of this
confidentiality requirement.
5. Other Provisions.
A. The term of this Agreement shall be from July 1, 2015 through June 30, 2020. The Agreement may be
renewed for additional terms by the mutual consent of both parties.
B. Either party may terminate this Agreement for any reason by providing thirty (30) calendar days' written
notice to the other party of its intention to terminate, provided that students shall be permitted to complete
internships that began prior to the termination notice.
C. Any amendments to this Agreement must be in writing and signed by both parties.
ID. This Agreement shall be construed and enforced in accordance with the laws of the State of Arizona.
E. Nothing contained herein shall be deemed or construed as creating a relationship of principal and agent or of
partnership or of joint venture between the parties.
F. This Agreement shall be binding upon and shall inure to the benefit of parties and their respective
successors, heirs, assigns and legal representatives. Neither this Agreement nor any rights hereunder may be
assigned without the prior written consent of the non-assigning party.
G. This Agreement contains the entire understanding of the parties relating to the subject matter of this
Agreement. Any prior agreements, promises, negotiations or representations between the parties, either
oral or written, relating to the subject matter of this Agreement which are not expressly set forth herein are
of no force or effect. Any modifications or amendments must be agreed to by both parties in writing and
shall become effective on the date stated herein.
H. 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 the negligent performance of
this Agreement, 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, its
officers, officials, agents, employees, or volunteers.
(signature page follows)
Benedictine University Internship Affiliation Agreement 07,09.14

BENEDICTINE UNIVERSITY MARICOPA COUNTY, by and for its DEPARTMENT OF PUBLIC
HEALTH
By: By:
Michelle Koppitz Chairman, Maricopa County Board of Supervisors
Vice President, Adult & Professional Studies
Attest:
Clerk of the Board
7-7 2
Date: Date:
By: By:
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Date:
Title
Date:
By: By:
Approved as to Form
Deputy County Attorney
Title
Date:
Date:
Benedictine University Internship Affiliaticn Agreement 07.09.14