APPENDIX E
MEMORANDUM OF AGREEMENT
UNIVERSITY OF SOUTHERN MAINE
and
_____________________
FOR SCHOOL OF SOCIAL WORK
This Agreement made and effective this first day of September, 2011 by and between
___________________________, and UNIVERSITY OF MAINE SYSTEM, acting through
University of Southern Maine, shall be for the purpose of establishing a social work field work
experience within the educational program.
The School of Social Work at the University offers programs leading to the baccalaureate
degree (BSW) or master’s degree (MSW) in social work. The undergraduate program prepares
students to work with diverse populations across multiple levels from a social justice, community
oriented perspective. The MSW prepares graduates for Advanced Social work practice.
Students in the BSW program must complete 480 hours of field work. The MSW program
student also participates in field work. During the 1st year they complete 500 hours and in the
2nd year 600.
This Agreement applies to the following programs: BSW, MSW.
NOW, THEREFORE, IN CONSIDERATION OF the mutual covenants contained herein, the
parties hereto agree as follows:
THE AGENCY AGREES TO:
Assign a qualified Field Instructor for the Student. This involves assigning a Field
Instructor who meets the criteria outlined by the School of Social Work and
providing the Field Instructor with sufficient release time and resources to carry
out the responsibilities of this position. It may also involve ensuring supervision
of the Field Instructor in the skills and responsibilities of field instruction.
Notify the Student of any potential health or safety hazards in the work environment,
including notification of any potential exposure to blood borne pathogens and the
Agency’s protocol on blood borne pathogens. The Agency shall comply with all
regulations and laws Including those affecting health and safety and exposure to
blood or other potentially infectious bodily fluids, including providing to Students
the same testing and counseling provided to the Agency’s employees.
Provide working space and other resources as needed by the Student for the
performance of field assignments.
Notify the Faculty Liaison or Field Coordinator of the School of any changes in
Agency personnel or resources that would affect the Student’s learning
opportunities.
Conduct the programs and services of the Agency in a manner consistent with the
guidelines for professional conduct articulated in the NASW Code of Ethics.
Indemnify and hold the University harmless from and against any and all claims,
actions, lawsuits, judgments and costs, including reasonable attorney’s fees, that
the University may become liable to pay or defend due to bodily injury or property
damage caused by the negligent acts or omissions of the Agency, its employees
or agents, or a University student acting at the direction of the Agency, its
employees or agents, arising out of or in connection with the Agency’s
participating in the Program pursuant to this Agreement.
Maintain the insurance coverage and limits listed below to protect the Agency and
the Agency employees performing work covered by this agreement:
Insurance Type
Coverage Limit
a. Medical Professional Liability
$2,000,000 coverage or higher
b. Commercial General Liability
$1,000,000 per occurrence or more
(Written on an Occurrence-based
(Bodily Injury and Property
form)
Damage)
The Agency shall provide the University with original Certificates of Insurance for
As certificate holder, the University should be included as follows:
The University of Maine System
Office of Facilities
107 Maine Avenue
Bangor, ME 04401
Arrange for emergency care, if available, for Students or faculty members who are
injured or become ill while participating in the field learning experience,
and notify the Director of the School of Social Work or her/his designee. It is
understood
that students (or their parents or guardians as the case may be) or
faculty members shall be responsible for their own medical expenses, whether
incurred at the Agency or elsewhere.
II.
THE UNIVERSITY AGREES TO:
Conduct the Program in accordance with the philosophy and policies of the
University, the Agency and other associations affecting this Program.
Provide for the ongoing coordination of the student’s learning experiences at the
Agency through the Director of the School of Social Work.
Explain the philosophy and purposes of the Program to the Agency.
Furnish the Agency with the field work objectives.
Appoint as University of Southern Maine Liaison a School of Social Work faculty
member who will be responsible for coordinating activities between the Agency
and University of Southern Maine and to serve as liaison between the School of
Social Work and the Agency, its administrators and Field Instructors.
Plan and evaluate cooperatively with the Agency the student’s learning experiences
at the Agency.
Assign to Field Experiences only those of University of Southern Maine’s Students
who are in good academic standing and who have fulfilled the prerequisites for
that practicum experience.
Encourage in the student appropriate attitudes and relationships as members of the
Agency in order to engender a cooperative spirit.
Inform Students that they are subject to, and expected to comply with, the rules,
regulations and policies of the Field Experience site, as is reasonable for the
purposes of this Agreement.
Accord the Agency the right to suspend or terminate the affiliation of any student for
reasons of unsatisfactory performance, a medical condition which renders the
student unable to perform Program requirements, or other reasonable causes.
Any action which may result in suspension or termination will not take effect until
a University representative and an Agency representative have discussed the
situation and have come to an agreement on the appropriate action to be taken.
This does not limit the right of the Agency in its sole discretion on any specific
occasion to deny the privilege of practice or participation in the program at the
Agency when in the considered opinion of the Agency, it is in the best interest of
its clients to do so.
Indemnify and hold the Agency harmless from and against any and all claims,
actions, lawsuits, judgments and costs, including reasonable attorney’s fees, that
the Agency may become liable to pay or defend due to bodily injury or property
damage caused by the negligent acts or omissions of the University, its
employees or students, except for a University student acting at the direction of
the Agency, its employees or agents, arising out of or in connection with the
University’s participating in the Program at the Agency pursuant to this
Agreement, PROVIDED that any liability of the University under this Agreement
shall be limited by the provisions and limitations of the Maine Tort Claims Act, 14
M.R.S.A.
§ 8101, et seq.
Maintain, and on request to furnish proof of, commercial general liability insurance
(including coverage for professional malpractice of students while in practicum) in
an amount of coverage of not less than $1,000,000 per occurrence.
III.
BOTH PARTIES AGREE:
University Liaison shall visit at least once during each semester to evaluate student
learning.
University faculty shall not be classified as employees of the Agency, and shall not
be entitled to any payment from the Agency in the nature of benefits under the
Maine Worker’s Compensation Act for any accident, illness, occurrence or event
relating to the Agency and arising out of the Program or for any other purpose.
Students shall not receive any financial compensation from the Agency for their
participation in the Program. Nothing in this Agreement shall preclude receipt by
the Agency of compensation from any person for any service performed by a
student in the Program. It is intended that for all purposes the students shall be
students of the University and not employees of the Agency or the University.
Student(s) shall be treated as trainees who have no expectation of receiving
compensation or future employment unless, prior to the beginning of the Field
Experience the Student(s) is employed by the Agency for the performance of
duties and obligations other than those contained in this Agreement and or part
of the Field Experience, and the Agency Field Instructor supervising the
Student(s) does not supervise the performance of the Student(s) employment
related duties and obligations.
At no time shall either party discriminate against students on the grounds of race,
color, religion, sex, sexual orientation, national origin or citizenship status, age,
disability, or veteran status.
Both parties agree to be responsible for their own equipment used in the activities of
the program.
The terms of this Agreement may be modified only upon the mutual written consent
of the parties.
This Agreement may be terminated by the mutual assent of both parties or by either party upon ninety
(90) days written notice to the other party. In the event of termination of this Agreement as
specified above, the University shall have the right to complete the clinical affiliation for any
student presently enrolled in the program.
NAME OF AGENCY
By:____________________________________
___________________
Signature
Date
(please print)
Name:
Title:
Address:
By: ____________________________________
____________________
John Wright
Date
Interim Provost and Vice President for Academic Affairs
University of Southern Maine
By: ____________________________________
_____________________
Susan Fineran
Date
Director, School of Social Work
University of Southern Maine