AFFILIATION AGREEMENT THIS AFFILIATION AGREEMENT (“Agreement”) is made and entered into as of September 29, 2009 (“Effective Date”), by and between of , on behalf of its and Information Sciences (“University”), and University Pediatrics Foundation, Inc. d/b/a Child Health Specialists, Inc. (“Practice Site”). PURPOSE Agreement establishes an affiliation between University and Practice Site in which Practice Site is designated as and agrees to serve as a community-based public health practice site for one or more academic or professional programs of University (“Program”), and sets forth the responsibilities of the parties and the terms and conditions of the affiliation established. RESPONSIBILITIES OF UNIVERSITY University may request that one or more students enrolled and in good standing in Program (“Student”) be assigned to Practice Site. University personnel will collaborate with Practice Site personnel in the determination of appropriate educational assignments for Student as part of Program. Student assignments may vary, including without limitation, one-day site visits, projects over several weeks, and large projects over several months. University will maintain general responsibility for academic evaluation and related academic matters involving Student’s assignment at Practice Site. University may require Student to develop and execute, in conjunction with Practice Site and University, a Learning Contract that specifies the deliverables to Practice Site expected of Student as part of Student assignment at Practice Site. Such Learning Contract, however, shall not be construed as part of this Agreement. Determination of those assignments for which a Learning Contract is required is solely by University. University agrees to provide and maintain general liability insurance for a minimum amount of $1,000,000.00 per occurrence covering Student when physically present at Practice Site or another location as part of assignment to Practice Site, including travel between such locations. Upon request, University will provide Practice Site with a certificate of insurance evidencing such coverage. University will require Student to have health insurance, proof of which shall be furnished to Practice Site upon request. University will provide in-service training to Student on HIPAA and human subjects’ protection. When deemed appropriate by either University or Practice Site, University will require Student, with assistance from University and Practice Site personnel, to obtain either
AFFILIATION AGREEMENT THIS AFFILIATION AGREEMENT (“Agreement”) is made and entered into as of September 29, 2009 (“Effective Date”), by and between of , on behalf of its and Information Sciences (“University”), and University Pediatrics Foundation, Inc. d/b/a Child Health Specialists, Inc. (“Practice Site”). PURPOSE Agreement establishes an affiliation between University and Practice Site in which Practice Site is designated as and agrees to serve as a community-based public health practice site for one or more academic or professional programs of University (“Program”), and sets forth the responsibilities of the parties and the terms and conditions of the affiliation established. RESPONSIBILITIES OF UNIVERSITY University may request that one or more students enrolled and in good standing in Program (“Student”) be assigned to Practice Site. University personnel will collaborate with Practice Site personnel in the determination of appropriate educational assignments for Student as part of Program. Student assignments may vary, including without limitation, one-day site visits, projects over several weeks, and large projects over several months. University will maintain general responsibility for academic evaluation and related academic matters involving Student’s assignment at Practice Site. University may require Student to develop and execute, in conjunction with Practice Site and University, a Learning Contract that specifies the deliverables to Practice Site expected of Student as part of Student assignment at Practice Site. Such Learning Contract, however, shall not be construed as part of this Agreement. Determination of those assignments for which a Learning Contract is required is solely by University. University agrees to provide and maintain general liability insurance for a minimum amount of $1,000,000.00 per occurrence covering Student when physically present at Practice Site or another location as part of assignment to Practice Site, including travel between such locations. Upon request, University will provide Practice Site with a certificate of insurance evidencing such coverage. University will require Student to have health insurance, proof of which shall be furnished to Practice Site upon request. University will provide in-service training to Student on HIPAA and human subjects’ protection. When deemed appropriate by either University or Practice Site, University will require Student, with assistance from University and Practice Site personnel, to obtain either