MSRS Agreement
Affiliation Agreement Between
Midwestern State University and
This Affiliation Agreement (“Agreement”) between Midwestern State University (“University”) and
(“Agency”) entered into on this date,
.
The University and Agency do not and will not discriminate against any employee, student, or
applicant for employment or registration in the course of study because of race, creed, sex, or
nationality of origin. The Agency and University are both desirous of cooperating in a plan to furnish
educational and/or administrative experiences for graduate radiology students.
Specific Responsibilities of the Agency
1.
The Agency will make available to the graduate students the educational facilities including
necessary equipment and supplies, will provide conference room space to the extent reasonably
feasible, and will allow for use of available instructional material.
2.
Graduate students and Faculty will be provided, when available, a designated area in the
Agency to place personal items at their own risk.
3.
The Agency will provide adequate staffing in the educational areas so that no graduate student
or faculty member will be expected to give service in the Agency apart from that rendered for
its educational value as a part of the planned graduate educational program.
4.
The Agency will provide an opportunity for the Faculty to keep up to date with policies by
providing information regarding policy and/or procedural changes.
5.
Members of both Agency staff and the Radiology faculty of the University will cooperate in
concurrent and terminal evaluation of these student experiences, provided the student has
signed consent to the exchange of educational information in accordance with the Family
Educational Rights and Privacy Act of 1974, as amended. The University will obtain and retain
all required consents, and Agency will have the right to rely on such consents and to obtain
copies of such consents upon request. Any evaluation of students by Agency will relate only to
the general student participation in the educational program and will in no way be construed as
a certification by Agency as to the competence of any student or a representation by Agency of
any student’s ability or competence in connection with the practical implementation of any
knowledge gained through the program.
6.
The Agency does not assume any liability responsibility for graduate students’ personal injuries
and/or graduate student errors.
7.
Nothing in this Agreement will be construed to require Agency to provide or arrange for
medical or health care (emergency or otherwise) that a student or Faculty member may need
during his/her participation in the program at Agency. Any health care services that a student of
Faculty member receives during his/her participation in the program will be at the expense of
the individual involved.
MSU OGC/blm: form approved 10-16-2012
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MSRS Agreement
Specific Responsibilities of the University
1.
The University assumes full responsibility for offering a regionally accredited graduate
education program in Radiology. The Radiology faculty will be qualified both as teachers and
as competent practitioners. The University will retain ultimate responsibility for the education
of its students.
2.
The Radiology faculty of the University will plan all experiences of the graduate students, in
coordination with and subject to the approval of Agency. The educational experiences and the
dates of each student’s educational experience shall be by mutual agreement of the University
and Agency. Graduate student practicum placements will be made by a University faculty
member and will be subject to Agency approval.
3.
The University will ensure that graduate students and Faculty abide by existing rules,
regulations, policies and procedures of the Agency insofar as they may pertain to their
participation in activities at the Agency. Students shall be instructed by the University prior to
beginning the program concerning the confidentiality of information and records belonging to
the Agency.
5.
There will be a formal conference of involved University faculty representative(s) and from
respective Agencies units at least once each academic semester for the purpose of discussing
common concerns.
6.
The University shall ensure that all students have satisfied appropriate academic prerequisites,
are in good standing with the University, have had all immunizations and medical tests required
by Agency, and maintain health insurance throughout the entire term of their participation in
the program. The University shall provide Agency with evidence of such student’s health
insurance coverage prior to such student’s participation in the program. The University shall
maintain all personnel and academic records relating to students.
7.
Pursuant to this Agreement, but only to the extent permitted by Texas law and without waiving
any of the constitutional, statutory or common law rights privileges, immunities or defenses of
the parties, the University agrees to defend, indemnify, and hold the Agency harmless from
liability claims resulting from students’ acts and omissions and the Agency agrees to defend,
indemnify, and hold the University harmless from liability claims resulting from acts and
omissions committed by Agency’s employees.
Agency shall provide and maintain general comprehensive liability insurance and professional
liability insurance for itself, its agents, and employees. Such coverage shall be in an amount no
less than one million per occurrence and three million annual aggregate which shall be
considered primary insurance for Agency, its agents, and employees.
The University shall provide and maintain general comprehensive liability insurance and
professional liability insurance for itself, its agents, and employees. Such coverage shall be in
an amount no less than one million per occurrence and three million annual aggregate and shall
be considered primary insurance for the University, its agents, and employees.
The University shall ensure that each student shall be covered by general comprehensive
liability insurance, including professional liability coverage, for occurrences during the term of
this Agreement with limits no less than one million per occurrence and three million annual
aggregate.
MSU OGC/blm: form approved 10-16-2012
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MSRS Agreement
The insurance required above shall be in full force and effect prior to the commencement of the
program year. It shall not be modified or terminated except upon 30 calendar days prior
written notice to Agency. In the event any claims made policy is procured to meet the
insurance requirements hereunder, coverage shall also be procured for a period of four years
after termination of such policy.
Prior to the effective date hereof, the University shall provide Agency with a Certificate of
Insurance evidencing the above stated coverage and naming Agency as an additional insured.
8.
Either party may terminate this Agreement for material breach immediately upon delivery of
written notice of termination to the other party, or without cause, upon 90 calendar days prior
written notice to the other party.
Miscellaneous
This Agreement shall be governed by the laws of the State of Texas.
This Agreement contains the entire agreement between the parties pertaining to the subject matter
hereof, and supersedes all prior agreements and representations. No modification or amendment shall
be effective unless in writing and executed by both parties.
This Agreement shall not be deemed to create a relationship of Agency, employment, or partnership
between the Agency and either the University or its students.
The person signing this Agreement warrant that they have full authority to do so and that their
signature shall bind the parties for which they sign.
Neither party has the right or the power to assign this Agreement, in whole or in part, without the prior
written consent of the other party, and any purported assignment in contravention of this provision
shall be null and void.
Neither party shall use the names, trademarks, or service marks of the other party or its staff in any
publicity, public announcement, advertising, or promotion without the express prior written approval
of the other party.
Signed: ____________________________________
Administrator
(Agency)
Date:
Signed: ___________________________________
Radiology Department Representative
(Agency)
Date:
Signed_________________________________
Betty H. Stewart, Ph.D.
Provost & Vice President for Academic Affairs
Midwestern State University
MSU OGC/blm: form approved 10-16-2012
Date:
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