INTERNSHIPAFFILIATIONAGREEMENT
ThisINTERNSHIPAFFILIATIONAGREEMENT(“Agreement”)isenteredintoonthe_______dayof
_______________,20___,byandbetweenClaremontGraduateUniversity,throughitsSchoolof
CommunityandGlobalHealth(the"University"),and__________________________________(the
“Facility”).
Recitals
A.
AnintegralpartoftheUniversity'sMasterofPublicHealth("MPH")programissupervisedfield
trainingexperiencewithanapprovedfacilityforwhichstudentsreceiveacademiccredit.
B.
TheUniversitydesiresthecooperationofFacilityinimplementingsupervisedfieldinternship
programsinpublichealthatFacility’slocationandtrainingUniversitystudentsinthepractical
applicationsofpublichealth(“InternshipProgram”).
C.
FacilitywillbenefitfromthecontributionsoftheUniversity’sstudentsparticipatinginthe
InternshipProgram.
C.
FacilitywishestoassisttheUniversityinimplementinganInternshipProgram;
NOW,THEREFORE,inconsiderationofthemutualagreementssetforthherein,theUniversityandthe
FacilityenterintothisAgreementonthetermsandconditionssetforthbelow.
TheUniversity’sRightsandResponsibilities
1.
ToassignstudentstoFacilitywhomeettheUniversity’srequirementsandqualificationsto
participateintheInternshipProgram.
2.
ToappointaUniversityfacultyorstaffmemberas“InternshipDirector”toadministerthe
University’sresponsibilitiesrelatedtotheInternshipProgramandtooverseethestudents’field
experienceatFacility.
3.
ToestablishandmaintainongoingcommunicationwiththeFieldSupervisor,asdefinedbelow,
regardingtheInternshipProgram.
4.
TonotifytheFieldSupervisor,atatimemutuallyagreedupon,oftheUniversity’splanned
scheduleofstudents’assignments,includingthenamesofthestudents,levelofacademic
preparation,andlengthanddatesoftheinternshipexperiences.
5.
Toinformstudentsthattheyaretoobtainandmaintainadequatehealthinsurancecoverage
duringthetimethatstudentsparticipateintheInternshipProgramandtoprovideevidenceof
suchcoveragetoFacility,atFacility’sreasonablerequest.
6.
ToensurethatallstudentsparticipatingintheInternshipProgramatFacilitywillbecoveredby
professionalliabilityinsurancethroughtheUniversity’sinsurancecoverageintheamountsset
forthbelow.
7.
Todirecttheassignedstudentstocomplywiththeexistingpertinentrulesandregulationsof
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8.
9.
FacilityandallreasonabledirectionsgivenbyqualifiedFacilitypersonnel.
ToassumeresponsibilityforprovidinggradestothestudentsinconnectionwiththeInternship
Program.
ToinformFacilityintheeventthatastudentwithdrawsfromtheInternshipProgramor
otherwiseisunabletocompletetheInternshipProgram.
Facility’sRightsandResponsibilities
1.
Toprovideone(1)qualifiedFacilitysupervisor(“FieldSupervisor”)foreachstudentenrolledin
theInternshipProgram.AqualifiedfieldsupervisorisdeterminedbytheMPHfacultysupervisor
andasoutlinedintheMPHInternshipHandbook.Fieldsupervisorresponsibilitiesincludethe
following:
·
Meetwiththestudentpriortothecommencementofthefieldtrainingexperience;
OrientthestudenttotheFacility;
.
Withthestudent,developascopeofworkwhichillustratesclearlytaskstobe
completedbythestudent;
·
Assistthestudentingainingaccesstoinformationanddatarequiredfortheprojectto
becompletedbystudent;
·
Monitorstudent’sattendanceandmeetwithstudentinperson,ataminimum,one
hourperweek;
.
Provideguidanceandadvicetothestudentintheprogramareainwhichtheywillbe
located;
.
Keepincontact(inpersonorbyphone,etc.)fortheentirefieldworkperiod,duringthe
hoursthestudentsareinplacement;
.
AppointanotherstaffpersontosupervisethestudentwhentheFieldSupervisorisnot
available;
.
Completeallnecessaryformsinatimelymanner;
·
Submitafinalevaluationreportofthestudent’sperformance;
.
ReviewpoliciesandprocedureswiththeInternshipDirectoreitherinperson,duringa
sitevisit,orbyphone;and
·
Anyotherresponsibilitiesmutuallyagreeduponbytheparties.
2.
TocompleteanapplicationforfieldplacementstudentsandtocomplywiththeFieldInternship
ScopeofWork.
3.
ToprovidefieldexperiencesinaccordancewiththerequirementsoftheUniversity’scurriculum.
On-sitevisitswillbearrangedwhenfeasibleand/oruponrequestbytheUniversity.Facility
shalladvisetheUniversityofanychangesinitspersonnel,operationorpolicieswhichmay
materiallyaffectthestudents’fieldexperiencesortheInternshipProgramatFacility
4.
Toensurethatstudentsaregivendutiescommensuratewiththeirskillsandexperience.
5.
Toprovidethephysicalfacilities,resourcesandequipmentnecessarytooperatetheInternship
ProgramatFacility,includinguseoflibraryfacilities,reasonableworkandstoragespace.
6.
Todeterminethenumberofstudentswhichitcanaccommodateduringagivenperiodoftime
andnotifytheUniversitypromptlypriortothecommencementoftheInternshipProgram.
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ToprovidetheassignedstudentswithacopyoftheFacility’sexistingpertinentrulesand
regulationswithwhichthestudentsareexpectedtocomply.
Tomakeavailable,wheneverreasonablynecessary,emergencyhealthcarefortheassigned
students,thecostofwhichshallbebornebythestudents.
TorequesttheUniversitytowithdrawastudentfromtheInternshipProgramatFacilitywhen
student’sperformanceisunsatisfactorytoFacilityorstudent’sbehaviorisdisruptivetoFacility
oritsclients.Facilityshallstateitsreasonsforrequestingastudentwithdrawalinwritingtothe
InternshipDirector.Itisunderstoodthatexceptassetforthinparagraph10below,onlythe
UniversitycanwithdrawastudentfromtheInternshipProgramatFacility.
ToimmediatelyremovefromtheFacilityanystudentwhoposesanimmediatethreatordanger
topersonnelorthepropertyofFacility.
Tocomplywithallfederal,state,andlocallawsandordinancesconcerningtheconfidentialityof
studentrecords.
Tocomplywithallfederal,state,andlocallawsandordinancesconcerninghumansubject
researchifstudentsparticipateinaresearchprogramaspartofaresearchteam.
Tomaintaingeneralliabilityand/orworkers’compensationinsurancecoverageacceptableto
theUniversity(withminimumcoverageamountsassetforthbelow)tocovertheFacility,its
buildings,equipmentandmaterials,itsemployeesandagents,andanyclaimsrelatingtoactions
oromissionstakenbyFacility’spersonnel.
GeneralProvisions
1.
Non-discrimination.Thepartiesshallmakenodistinctionordiscriminateinanywayamong
studentscoveredbythisAgreementonthebasisofrace,color,sex(includingpregnancy),
religiouscreed,age,physicalormentaldisability,ancestry,sexualorientation,genderidentity,
maritalstatus,nationalorigin,oranyothercharacteristicthatisprotectedbylaw.
2.
CoordinationofInternshipProgram.Thepartiesshallusereasonableeffortstoestablishthe
educationalobjectivesfortheInternshipProgram,devisemethodsforitsimplementationand
continuallyevaluatetodeterminetheeffectivenessofthefieldexperience.
3.
StudentsNotUniversityEmployees.ThepartiesheretoagreethattheUniversity’sstudentsare
fulfillingspecificrequirementsforfieldexperiencesaspartofadegreerequirementand,
therefore,theUniversity’sstudentsarenottobeconsideredemployeesoragentsofeitherthe
UniversityortheFacilityforanypurpose,includingWorkers'Compensationoremployeebenefit
programs.
4.
Insurance.EachpartytothisAgreementshallprovideandmaintain,atitsownexpense,a
programofinsuranceorself-insurancecoveringitsactivitiesandoperationshereunder.Such
programofinsuranceorself-insuranceshallinclude,butnotbelimitedto,comprehensive
generalliability,professionalliabilityandworkers’compensation.Thegeneralliabilityinsurance
shallhaveaminimumcoverageof$300,000peroccurrenceandcost$500,000aggregate.The
professionalliabilityinsuranceshallcarryasinglelimitcoverageofnotlessthan$1,000,000per
occurrenceand$3,000,000aggregate.Uponwrittenrequest,eitherpartyshallprovidethe
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otherwithacertificateevidencingsuchcoverage.
Term.ThisAgreementshallbeeffectiveforaperiodofoneyearwhenexecutedbybothparties.
ThisAgreementwillbeautomaticallyrenewedannuallyunlessotherwiseindicatedinwritingby
oneofthepartiesatleastthirty(30)dayspriortotheendoftheterm,orunlessterminatedin
accordancewithparagraph6below.
Termination.ThisAgreementmaybeterminatedbyeitherpartywithorwithoutcauseupon
ninety(90)dayswrittennotice,providedthatallstudentscurrentlyenrolledintheInternship
ProgramatFacilityatthetimeofnoticeofterminationshallbegiventheopportunityto
completetheInternshipProgramatFacility.
Arbitration.Allcontroversies,claimsanddisputesarisinginconnectionwiththisAgreement
shallbesettledbymutualconsultationbetweenthepartiesingoodfaithaspromptlyas
possible,butfailinganamicablesettlementshallbesettledfinallybyarbitrationinaccordance
withtheprovisionsofthisparagraph.SucharbitrationshallbeconductedinLosAngeles
County,California,inaccordancewiththeCommercialArbitrationRulesoftheAmerican
ArbitrationAssociation(“AAA”).Thepartiesheretoherebyagreethatthearbitrationprocedure
providedforhereinshallbethesoleandexclusivemethodofresolvinganyandallofthe
aforesaidcontroversies,claimsordisputes.Thecostsandexpensesofthearbitrationshall
initiallybesharedequallybybothparties,butultimatelywillbedeterminedbythearbitrator.
Theprevailingpartyinanyarbitrationwillbeentitledtorecoveryofallcostsandattorneys’fees
expendedinthearbitration.
(a)
JudicialAction.Legalactionfor(i)entryofjudgmentuponanyarbitration
awardor(ii)adjudicationofanycontroversy,claimordisputearisingfromabreachor
allegedbreachofthisparagraph7maybeheardortriedonlyinthecourtsoftheState
ofCaliforniafortheCountyofLosAngelesortheFederalDistrictCourtfortheCentral
DistrictofCalifornia.Eachofthepartiesheretoherebywaivesanydefenseoflackofin
personamjurisdictionofsaidcourtsandagreesthatserviceofprocessinsuchaction
maybemadeuponeachofthembymailingitcertifiedorregisteredmailtotheother
partyattheaddressprovidedforinthisAgreement.Bothpartiesagreethatthe
prevailingpartyinanysuchjudicialactionshallbeentitledtorecoverfromthenonprevailingpartyreasonableexpenses,includingwithoutlimitation,attorneys’fees.
NoAgency.Bothpartiesacknowledgethattheyareindependentcontractors,andnothing
containedhereinshallbedeemedtocreateanagency,jointventure,franchiseorpartnership
relationshipbetweentheparties,andneitherpartyshallsoholditselfout.Neitherpartyshall
havetherighttoobligateorbindtheotherpartyinanymannerwhatsoever,andnothing
containedinthisAgreementshallgiveorisintendedtogiveanyrightofanykindtothird
personsnotsignatorytothisAgreement.
Assignment.Neitherpartyheretoshallhavetheright,directlyorindirectly,toassign,transfer,
conveyorencumberanyofitsrightsorresponsibilitiesunderthisAgreementwithouttheprior
writtenconsentoftheotherparty.Subjecttotheforegoing,thisAgreementshallbebinding
uponandinuretothebenefitoftherespectivesuccessorsandassignsoftheUniversityand
Facility.
GoverningLaw.ThisAgreementshallbeconstruedinaccordancewithandalldisputes
regardingthisAgreementshallbegovernedbythelawsoftheStateofCalifornia.
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Severability.IfanytermorprovisionofthisAgreementisforanyreasonheldtobeinvalid,such
invalidityshallnotaffectanyothertermorprovision,andthisAgreementshallbeinterpretedas
ifsuchtermorprovisionhadneverbeencontainedinthisAgreement.
Notice.AllnoticestobegivenunderthisAgreement(whichshallbeinwriting)shallbegivenat
therespectiveaddressesofthepartiesassetforthbelow,unlessnotificationofachangeof
addressisgiveninwriting.AnynoticerequiredbythisAgreementshallbedeemedtohave
beenproperlyreceivedwhendeliveredinpersonorwhenmailedbyregisteredorcertifiedfirst
classmail,returnreceiptrequested,orbyFederalExpresstotheaddressasgivenbelow,orsuch
addressesasmaybedesignatedfromtimetotimeduringthistermofthisAgreement.
ClaremontGraduateUniversity [NameofFacility]
SchoolofCommunityandGlobalHealth
[Address_____________________]
675WestFoothillBlvd,Suite310
____________________________
Claremont,CA91711 ____________________________
909.607.6729 [Phone______________________]
AuthoritytoSign.Thepartiessigningbelowareauthorizedandempoweredtoexecutethis
Agreementandbindthepartiestothetermsandconditionscontainedherein.
NoThirdPartyBeneficiaries.ThisAgreementshallnotcreateanyrights,includingwithout
limitationthirdpartybeneficiaryrights,inanypersonorentitynotapartytothisAgreement.
NoWaiver.Anyfailureofapartytoenforcethatparty’srightunderanyprovisionofthis
Agreementshallnotbeconstruedoractasawaiverofthatparty’ssubsequentrighttoenforce
anyprovisionscontainedherein.
EntireAgreement.ThisAgreementfullysupersedesanyandallprioragreementsor
understandingsbetweenthepartiesheretooranyoftheirrespectiveaffiliateswithrespectto
thesubjectmatterofthisAgreement,andnochangein,modificationof,oraddition,
amendmentorsupplementtothisAgreementshallbevalidunlesssetforthinwritingand
signedanddatedbybothpartiesheretosubsequenttotheexecutionofthisAgreement.
LimitationofLiability.Tothemaximumextentpermittedbylawandexcludingabreachofany
termofthisAgreement,innoeventwilleitherpartyberesponsibletotheotherforany
incidentaldamages,consequentialdamages,exemplarydamagesofanykind,lostgoodwill,lost
profits,lostbusinessand/oranyindirecteconomicdamageswhatsoeverregardlessofwhether
suchdamagesarisefromclaimsbaseduponcontract,negligence,tort(includingstrictliabilityor
otherlegaltheory),andregardlessofwhetherapartywasadvisedorhadreasontoknowofthe
possibilityofincurringsuchdamagesinadvance.
ClaremontGraduateUniversity,
OnbehalfoftheSchoolofCommunityandGlobalHealth
By:
________________________________
JacobE.Adams,Jr.
ExecutiveVicePresident&Provost
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CGUapprovalastoformandcontentonly:
By:
________________________________
StewartDonaldson,PhD
DeanoftheSchoolofCommunity&GlobalHealth
“FACILITY”
By:
__________________________________
[Name]
[Title]_____________________________
Pleasereturnthisagreementto:
DarleenPeterson,PhD,MPH,MCHES
AssociateProfessor&Director
MPHProgram
ClaremontGraduateUniversity
675W.FoothillBlvd.,Ste.310
Claremont,CA91711
Phone:(909)607-6729
Fax:
(909)592-8411
e-mail:darleen.peterson@cgu.edu
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