AMENDMENT TO AFFILIATION AGREEMENT.PDF

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AMENDMENT TO THE  
AFFILIATION AGREEMENT 
BETWEEN 
MARICOPA COUNTY  
ADMINISTERED BY ITS 
HUMAN SERVICES DEPARTMENT 
AND 
[NAME OF INSTITUTION] 
 
Agreement #:   
 
 
Amendment Amount: $ 
 
 
 
Agreement Start Date:  
 
 
 
 
Agreement Termination Date:  
 
 
 
 
 
I. 
Maricopa County (“County”) administered by its Human Services Department and [Name 
of Institution] (“School”) entered into a financial Affiliation Agreement (“Agreement”) on or 
about [Date of final signature]. The purpose of the Agreement is to identify senior nursing 
students (“Students”) to participate in the County’s Student Nurse Practice Readiness 
Program (the “Program”). The Students will be placed with local clinical employers which 
will provide hands-on training experiences as part of their overall education and which 
may qualify for academic credit, as determined by the School. 
 
The School and the County are collectively referred to as the “Parties” and individually as 
a “Party.” 
 
II. 
The Parties agree to enter into this Amendment No. 1 to amend the Agreement as follows: 
A. 
Extend the termination of the Agreement from December 31, 2022, through 
December 31, 2026. 
B. 
The School shall continue to work with Robin Schaeffer Consulting, LLC., the 
(“Project Manager”) between the County and the School for the Program activities. 
C. 
The School shall identify XX of students per year to participate in the Program. 
D. 
The County shall provide the School with funds for student capstone experience 
oversight: 
1. 
BSN Faculty=$400 per student; 
2. 
ADN Faculty = $300 per student; 
3. 
Nursing student stipend (grant towards nursing license and nursing boards 
@$250 per student) 
4. 
The total funding amount for the extension period shall not exceed $XXXX 
 
III. 
Section II above contains all the changes made by this Amendment No. 1. All other terms 
and conditions of the Agreement shall remain in full force and effect as executed by the 
Parties. 
IV. 
The Parties authorized the undersigned to execute this Amendment No. 1 on their behalf, 
and it shall be effective upon approval and signature by the Parties. 
 
[Signatures contained on following page]

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IN WITNESS, the Parties have approved and signed this Agreement as of the respective dates 
written below. 
 
[Name of Institution] 
 
 
By: ______________________________ 
 
Name: ____________________________ 
 
Title: _____________________________ 
 
Date: ____________________________ 
 
MARICOPA COUNTY 
 
 
By: ________________________________ 
 
Name: _____________________________ 
 
Title: Chairman, Board of Supervisors 
 
Date: _______________________________ 
 
 
ATTESTED TO: 
 
 
By: ________________________________ 
Clerk of the Board                            Date 
 
 
 
APPROVED AS TO FORM: 
 
 
By: ________________________________