VOCATIONAL_TRAINING_INSTITUTES_AFFILIATION_AGREEMENT.PDF

Pima Medical Institute
Campus Affiliation
Agreement
This affiliation agreement is entered into between Vocational Training Institutes, Inc., an Arizona corporation
dba Pima Medical Institute and:
Facility Name:
MCACC
Address:
2500 S 27th Ave
Phoenix, AZ 85009
hereinafter referred to as THE FACILITY.
THE FACILITY provides medical services and is willing to affiliate with PIMA MEDICAL INSTITUTE to
conduct an externship / clinical / fieldwork experiences on the terms and conditions set forth herein.
DUTIES OF PIMA MEDICAL INSTITUTE:
PIMA MEDICAL INSTITUTE agrees to:
Plan the educational program in the FACILITY, including programming, administration,
1.
matriculation, promotion and graduation
Maintain records and reports of the student's externship experience for a period of at least three
2.
(3) years.
Notify the FACILITY in advance of the planned externship/clinical/fieldwork of: student name,
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program of study, begin date, contact information for PIMA MEDICAL INSTITUTE's Career
Services Advisor, Clinical Director, or contact person, and the total number of hours student is
required to complete. A proposed student work schedule will require approval by the FACILITY,
which shall not be unreasonably withheld.
Use all reasonable effort to facilitate compliance by an assigned student with the rules and
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regulations of the FACILITY, including preservation of the confidential nature of information of the
patients and their records
Provide a copy of the performance objectives for the externship/clinical/fieldwork experience and
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endeavor to assure that the student is prepared for meeting those objectives.
Provide the necessary paperwork for the FACILITY'S evaluation of the student's performance
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while on externship.
Indemnify and hold harmless, to the extent of its professional liability insurance, the FACILITY
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from all claims, losses, liabilities, costs and expenses, including attorney's fees, arising in whole
or in part from any alleged act or omission of an assigned student, instructor, employee or any
other representative of PIMA MEDICAL INSTITUTE.
Provide evidence of liability insurance coverage or of financial responsibility acceptable to the
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FACILITY, as assurance of its accountability for any such losses, claims, liabilities or expenses.
Provide evidence of student professional liability coverage, in an amount not less than
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$1,000,000 per occurrence, $3,000,000 aggregate.
Provide only relevant and material student information and medical data required by the facility.
10.
Personally identifiable student information includes, but is not limited to: name, contact
information, vaccination documentation, medical history, background check, drug screen reports,
and fingerprints.
Train students in HIPAA requirements prior to the start of externship/clinical/fieldwork.
11.
Docusign Envelope ID: A03237DC-FA9B-4DE4-B602-B2836956F7FC

Pima Medical Institute
DUTIES OF THE FACILITY:
THE FACILITY:
Shall retain the right, in its sole discretion, to exclude any individual at any time from the
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externship/clinical/fieldwork area. PIMA MEDICAL INSTITUTE shall be notified of any such
occurrence.
Has the right to terminate any student from the externship/clinical/fieldwork program upon giving
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notice to PIMA MEDICAL INSTITUTE for reasonable cause, including without limitation, any
situation which may adversely affect patient care.
Will make available, at no charge, the externship/clinical/fieldwork area and the practical
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instruction for the externship/clinical/fieldwork experience. Students will not replace staff or give
services to patients aside from its educational value.
Will endeavor to assure that the educational experience provided by the FACILITY shall be of
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such quality as to provide the student with a sound externship/clinical/fieldwork experience and
will reinforce professionalism.
Will provide mentorship and appropriate supervision, throughout the entire scheduled term of the
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externship/clinical/fieldwork experience. Should the facility have an employment arrangement
with the student, the site agrees to adhere to the educational program plan for the student's
experience.
Any staff person who supervises the student is considered to have a legitimate educational
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interest and is required to follow Family Education Rights and Privacy Act of 1974 (FERPA). The
facility will not disclose or share any Student Data, except when it is de-identified. The facility will
not sell any personally identifiable student information to any third party.
Agrees to utilize reasonable administrative, physical, and technical safeguards designed to
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protect student information from unauthorized access, disclosure, acquisition, use or modification.
Examples of these include limiting access to student data on a "need to know" basis, use of "two-
factor" authorization, limiting number of log-in attempts and/or using strong encryption when
transmitting student data.
Will retain the student information for the minimum duration of time necessary.
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Shall adhere to any applicable state and federal law relating to data security.
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Will ensure that any third-party servicers are compliant with applicable laws and utilize data
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security measures.
In the event the facility maintains confidential information about the student (e.g., SSN, birth
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date), the facility shall provide PMI and student with notification of any security breach
(unauthorized release, disclosure, or acquisition of personally identifiable student information)
within 72 hours of confirmation of the incident unless notification within this time limit would
disrupt investigation of the incident by law enforcement. In such an event, notification shall be
made within a reasonable time after the incident. The facility will provide:
student's name and contact information
i.
list of types of personal information that were or are reasonably believed to have been the
ii.
subject of a breach
If known, either the date (or estimated date, or date range) of the breach
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general description of the breach incident
iv.
Docusign Envelope ID: A03237DC-FA9B-4DE4-B602-B2836956F7FC

Pima Medical Institute
TERM AND TERMINATION:
This agreement shall be for the term set forth below.
This AFFILIATION AGREEMENT shall be reviewed annually and will remain in effect until
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terminated by either party upon ninety days (90) days prior written notice, either by personal
service or by certified or registered mail addressed to the PIMA MEDICAL INSTITUTE
representative signing this Agreement on behalf of the FACILITY, as designated below.
Any students enrolled in the ongoing programs at the time of any such termination shall be given
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the opportunity by the FACILITY and PIMA MEDICAL INSTITUTE to complete the requirements
of the program as offered at the time of their entry and in compliance with the conditions
contained in this AFFILIATION AGREEMENT.
MISCELLANEOUS:
All participants in PIMA MEDICAL INSTITUTE programs agree to abide by existing rules and any
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rules or regulations implemented by the FACILITY during their externship.
Neither PIMA MEDICAL INSTITUTE nor the FACILITY will discriminate against any person
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because of race, color, religion, sex or national origin.
This AFFILIATION AGREEMENT shall be subject to review, as the need may arise, in order to
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consider any amendment, alteration or change, as may be mutually agreed upon in writing by
PIMA MEDICAL INSTITUTE and the FACILITY.
This Agreement contains the entire understanding of the parties and supersedes any prior
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understandings and agreements, written or oral.
Vocational Training Institutes, Inc., an Arizona corporation dba Pima Medical Institute
Facility Signature
Campus Director Signature
Digitally signed by Maria Walters on February 6, 2026 4:52PM
APPROVED AS TO FORM:
By: ___________________________
Deputy County Attorney
Printed Name:  Kim Miles
Date: _________________________
ATTEST:
By: _________________________
Clerk of the Board
Printed Name: Juanita Garza
Date: _______________________
MARICOPA COUNTY:
By: _________________________
Chair, Board of Supervisors
Printed Name: Kate Brophy McGee
Date: _______________________
Docusign Envelope ID: A03237DC-FA9B-4DE4-B602-B2836956F7FC
3/17/2026