Externship Agreement

This Agreement is between and .


The purpose of this agreement is to establish guidelines and responsibilities for the clinical and/or administrative education component for students enrolled at

This agreement goes into effect:

General Responsibilities:

1. does not discriminate on the basis of race, color, religion, national origin, marital status, disability, gender, sexual orientation, age or political affiliation.
2. Student assignments planned by the instructor in consultation with the appropriate supervisory personnel will be designed to meet the educational needs of the students and in accordance with available opportunities and experiences.
3. Clinical scheduling shall be in accordance with the program’s curriculum and the affiliating agency’s standard operating procedures.
4. It is understood and agreed by all parties that students and instructors of are not employees of the affiliating agency. As such, they are not entitled to wages, workers compensation, medical or liability insurance, or any other employee benefits for activities related to clinical experience provided for under this agreement.
5. Students are not entitled to jobs with the affiliating agency upon program completion. Responsibilities:

1. Become familiar with the affiliating agency and the policies prior to activation of student experiences.
2. Be responsible for planning student experiences in consultation with appropriate agency representatives.
3. Be responsible for supervising and/or coordinating student experiences to facilitate optimum client care, final evaluation of student performance is ultimately the responsibility of the instructor of record.
4. Assist with orientation of agency personnel to the aims, objectives, and educational methods of the program.
5. Be covered and require students to be covered by limited professional liability insurance with minimum limits of $1,000,000.00 per occurrence while assigned to the clinical areas of the affiliating agency.
6. Provide student orientation and require compliance with standards of conduct set by the affiliating agency.
7. Require students to have all health screening and evaluations required by the affiliating agency prior to beginning the clinical experience in the facility.
8. Remove without notice any student from the clinical area for violation of the affiliating agency’s policies, standards or procedures, when such violations present a danger to patients, staff, visitors or the premises.
9. Provide training to the student prior to assignment in the clinical area of the facility in the U.S. Occupational Safety and Health Administration (OSHA) guidelines on bloodborne pathogens and use of standard precautions and the Health Insurance Portability and Accountability Act (HIPAA) privacy requirements.
10. Plan with agency representatives to evaluate the program as needed.

Affiliating Agency Responsibilities:

1. Serve as a clinical setting in which students may be assigned for educational experience.
2. Provide staff time for planning with instructor’s suitable student experiences.
3. Provide faculty orientation to the agency’s setting and its policies and retain full responsibility for the care of patients.
4. Provide personal protective equipment, e.g., gloves, masks, etc., to students to enable them to practice Standard Precautions and other safety procedures.

Duration and Review:

This Memorandum of Agreement shall be effective from the date of its acceptance and shall be reviewed annually. Any revisions should be mutually agreeable at the time of annual review; the duration of the agreement shall be continuous. Either party may terminate the agreement upon written notice of at least 90 days in advance.

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Signed by MedCertify Education
Signed On: May 11, 2022

Signature Certificate
Document name: Externship Agreement
lock iconUnique Document ID: 68f7a6662d6d16fee07eab53e448a3f68904d669
Timestamp Audit
May 11, 2022 9:50 AM EDTExternship Agreement Uploaded by MedCertify Education - [email protected] IP
May 11, 2022 9:55 AM EDTMedCertify Documents - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip:
May 11, 2022 11:10 AM EDTMedCertify Documents - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: