ࡱ> []Z_ :bjbjJJ 0V(3b(3b2 $$$$Dh,$l54444444$78:55&5sss4s4ssj-10op/24<50l50:'L:d11J:O1s55sl5: B : UNIVERSITY OF IDAHO CONTRACT Agreement for Cooperation in a Clinical Experience Program XXXX-XXXX Academic Years This contract made and entered into by and between the Board of Regents of the 91av (University) and the Insert Site Name (Site). WITNESSETH: That the University and the Site, hereby agree jointly: To cooperate in the development of a clinical experience program at the Site, subject to the provisions below; That the University will select and assign the students in the Athletic Training Program to participate in the clinical education opportunity provided for in this agreement. In assigning the students, the University will select students who meet the following criteria: 2.1: Is a student in good standing in the Masters of Science in Athletic Training Program and have successfully completed at least: Clinical Anatomy I (lower half of body), Care and Prevention of Injuries and Illnesses, Evaluation and Diagnosis I (lower half of body), Therapeutic modalities I (physical agents except electrical stimulation), & Principles of Rehabilitation (physiology and theories of rehabilitation) 2.2: Develops and obtains approval of goals and objectives to be achieved during the clinical education experience. 2.3: Has a professional demeanor and appropriate appearance to work in a professional setting, and has a positive professional image including punctuality and reliability. 2.4: Maintains confidentiality of medical and personal information gained concerning patients in the workplace setting in compliance with HIPPA laws; and 2.5: Keeps daily logs of experiences including sports coverage, clinical education experience hours, and examples of accomplishments achieved at the Site. 3. That the University and Site will consult, and mutually agree, to a detailed written plan for the clinical education opportunity. Any changes to the plan must be communicated and mutually agreed upon in writing by the University and the Site. In the event the University and the Site are unable to reach an agreement on the details of the plan, this agreement will automatically and immediately terminate the relationship between the University and the Site. 3.1: Based upon the Plan, University will finalize all details concerning athletic training student assignments prior to the beginning date of each clinical rotation. University will provide information to the Site regarding any previous clinical experience of assigned students. 3.2: University will maintain open communication with the Site during the students clinical education experience. The Site will be open to direct or indirect CAATE (national AT accrediting agency) visits during the CAATE Site 91av Process. University will also communicate throughout the course of the clinical rotation with Site to assess student progress. 3.3: Parties agree that in all circumstances Site is responsible for the care and well being of its patients. That the Site reserves the right to determine the number of athletic training students selected for placement at the Site during any term; That the Site will be responsible for selecting the Preceptors and for the daily supervision of the student: 5.1: The Preceptor will be trained by the 91av in accordance with the CAATE accrediting standards, in line with best practice 5.2: The Preceptor, if a certified athletic trainer, will provide the University with the following information prior to supervising any student: current BOC certification number and NATA membership number. 5.3: The Preceptor will provide a supervised clinical education experience based on the approved Plan. The Preceptor will provide opportunities that contribute to the development of the didactic and clinical skills of the athletic training student. The Preceptor will not place students into the position of making decisions or performing duties that should be carried out by a licensed health care professional To the extent required, Site will provide any uniforms, identification, and supplies. 5.4: Site must have a blood borne pathogens exposure plan. Additionally, site must have a posted Emergency Action Plan. All policies and procedures must be made available to the student for the clinical education experience. 5.5: The Preceptor will evaluate student progress and share this information with the student and the University. University will provide a written evaluation form to the Preceptor at the beginning of the clinical experience. Final evaluation will be discussed with the student at the end of the clinical rotation and signed by both student and Preceptor. The evaluation will be sent to the University and placed in the students file. Based, in part, on the evaluation, University will provide the final grade for the clinical experience; to the extent grades are assigned. 5.6: In the event of student injury or illness, Site shall provide emergency care to student and notify the University as soon as possible. Student is financially responsible for all associated costs for such care. 5.7: Subject to availability, the Preceptor may be contacted by the University to serve as a guest speaker. This may be in the form of speaking at a workshop, classroom setting, or in weekly education meetings and may occur 1-2 times per academic year. 5.8: Site retains the right to terminate the assignment of any student the Site determines in its discretion is unable and/or unwilling to meet the requirements of the clinician(s) and/or the clinical opportunity and/or is failing to follow the Sites rules and regulations. 5.9: Site shall comply with all applicable laws. Site understands the University may provide to Site certain student education records, as defined in the Family Education Rights Act (FERPA). The parties acknowledge the experience provided by Site is an educational experience, and that, to the extent educational records are provided to Site, there is a legitimate educational interest in disclosing the educational records. Site agrees that with respect to acts taken in relation to any educational records, such acts shall be subject to direction by University. Site agrees that it is subject to, and shall comply fully, with FERPA, including but not limited to all confidentiality and re-disclosure requirements. Site acknowledges that any records directly related to a student that it maintains or receives are education records, including any new student records Site may create. 6. That the University will assign a college faculty member, the Coordinator of Clinical Education, or other approved professional to serve as the instructor of record for the clinical education experience; such person will be responsible for coordinating services of the University including the orienting and advising of Preceptors for the Athletic Training Program. That University athletic training students are expected to comply with all rules and regulations of the Site while serving at the Site. 8. That the 91av represents and warrants that the university is protected against claims based upon the negligent conduct of students and faculty while participating in the program established hereunder on the Sites premises. This protection is provided through a self-funded liability program administered by the State of Idaho Office of Insurance Management. Limits of liability are $500,000 Combined Single Limits, which amount is the universitys limit of liability under the Idaho Tort Claims Act. The Site represents and warrants that the Site and its directors, employees, and agents are protected against claims based upon the negligent conduct of Site employees while participating in the program established hereunder on the Sites premises. This protection is provided by liability insurance of not less than $1,000,000 per occurrence and not less than $3,000,000 aggregate. Prior to any students participation in the clinical education program established hereunder the Site will provide the University with a certificate of insurance confirming coverage in not less than the above stated amount. 9. That, Subject to the limits of liability specified in Idaho Code 6-901 through 6-929, known as the Idaho Tort Claims Act, the University shall indemnify and hold Site, its agents and assigns, harmless from and/or against any and all claims, damages, and liabilities (including reasonable attorney's fees) that may be suffered or incurred and that arise as a direct result of and which are caused by the University's possession, operations or performance under this indemnification agreement. This indemnification does not apply when such claims, damages, and liabilities are the result of negligent acts, errors, omissions or fault on the part of Site, its agents or assignsincluding conditions of Sites premises, or when the claim or suit is made against Site by the University, the State of Idaho, or any of its agencies. Site shall promptly notify the 91av, Attn: Risk Management Officer, 875 Perimeter Drive MS 3162, Moscow, Idaho, 83844-3162, of any such claim of which it has knowledge and shall cooperate fully with the University or its representatives in the defense of the same. 10. That, Subject to the limits of liability specified in Idaho Code 6-901 through 6-929, known as the Idaho Tort Claims Act, the site shall indemnify and hold University, its agents and assigns, harmless from and/or against any and all claims, damages, and liabilities (including reasonable attorney's fees) that may be suffered or incurred and that arise as a direct result of and which are caused by the Site's possession, operations or performance under this indemnification agreement. This indemnification does not apply when such claims, damages, and liabilities are the result of negligent acts, errors, omissions or fault on the part of University, its agents or assignsincluding conditions of Universitys premises, or when the claim or suit is made against University by the Site. 11. Nothing contained in this agreement shall be construed as creating a joint venture, partnership, or agency relationship between the parties and/or the students. The students participating in the clinical opportunity pursuant to this Agreement shall be engaged in an educational experience and shall not be deemed in any manner as employees or agents of the Site or the University. Further, the students shall not have any third party beneficiary rights arising out of the terms and conditions of this agreement. 12. That the Athletic Training Programs Clinical Education Experiences shall be evaluated each year under the direction of the official representative of the Site and the Director of Clinical Experiences of the University; 13. That the Site agrees that it does not discriminate on the basis of race, color, religion, sex, age, national origin, or handicap. 14. That the University will provide the student intern with professional liability insurance coverage with limits $1,000,000 / $3,000,000. 15. That any legal proceeding instituted between the parties shall be in the courts of the county of Latah, state of Idaho, and each of the parties agrees to submit to the jurisdiction of such courts. It is further agreed that this Agreement shall be governed by the laws of the state of Idaho as an Agreement to be performed within the state of Idaho. IN WITNESS WHEREOF: The parties have caused this agreement to be executed as required by their respective governing boards. Site Name City, State, Zip Date_____________ BY__________________________________________ Signature Please type or print: ____________________________________________________ Name ____________________________________________________ Title 91av, Moscow, Idaho Date_____________ BY__________________________________________ Signature, For the Board of Regents of the 91av Name Title Julia McIlroy Director, Contracts and Purchasing Services The 91av does not discriminate on the basis of race, color, national origin, religion, sex, age, disability, or status as a Vietnam-era veteran, as each of these bases is defined by law, in employment of, in admission to, or the operation of its educational programs and activities, as proscribed by titles VI and VII of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, Executive Order 11246 as amended, the Rehabilitation Acts of 1973, the Vietnam Era Veterans Readjustment Assistance Act of 1974, the Age of Discrimination Acts of 1974 and 1975, and other federal and state laws and regulations. Inquiries concerning the application of these laws and regulations to the University may be directed to the Universitys Affirmative Action Office or to the director, Office for Civil Rights, U.S. Department of Health, Education, and Welfare, Washington, D.C. 20201. Xaop      1 5   6 @ v y H R p s t ʻ﫜﫻ګﻍuiiih~~CJOJQJaJhVtFCJOJQJaJhtCJOJQJaJhA>.huCJOJQJaJhA>.hY&CJOJQJaJhA>.hY&5CJOJQJaJhA>.h`CJOJQJaJhA>.hQz5CJOJQJaJ(hA>.hu5B*CJOJQJaJphhA>.h`5CJOJQJaJ)Xqr  M N q .$! & F h^h`gdA>. p^p`gdA>. & FgdA>. & FgdA>.$a$t 01n9C*,vǸǸvggǎǬhA>.hECJOJQJaJhf-YCJOJQJaJhK\dCJOJQJaJhA>.hCJOJQJaJhA>.hELCJOJQJaJh07tCJOJQJaJhA>.h,oJCJOJQJaJhA>.h`CJOJQJaJhA>.h_CJOJQJaJhtCJOJQJaJhA>.huCJOJQJaJ''V` "#)21]fʾ诣ʣʯsdhA>.hWCJOJQJaJh\CJOJQJaJhWCJOJQJaJh HTCJOJQJaJhWCJaJhWh=CJOJQJaJhA>.h HTCJOJQJaJh6CJOJQJaJhA>.hCJOJQJaJhA>.h`CJOJQJaJh07tCJOJQJaJhFCJOJQJaJ"!"  x!y!""u#v##"$o$`gdgRgdgRh^hgd; & F>^`>gdA>.h^hgd& h^h`gdA>.gdA>. p^p`gdA>. & Fr{!*  w!y!|!!!!"F"""""#B#P#U#Y#h#t#u#廬٬قَٝssssshA>.h&CJOJQJaJh+V\CJOJQJaJhA>.h`CJOJQJaJhA>.hnCJOJQJaJhA>.hTCJOJQJaJhA>.h^KCJOJQJaJhA>.hECJOJQJaJh=CJOJQJaJhA>.h HTCJOJQJaJhH)CJOJQJaJ,u#v#w#z#|#]$b$%%%%%&)&t&x&6'?'f'g'l'o''''')(3(V(k((({******1+5+++H,I,J,,,,ӳӤӤӤӤӤӤӕhA>.hn>*CJOJQJaJhA>.h4`CJOJQJaJhA>.h CJOJQJaJhA>.h$T6CJOJQJaJhA>.h$T>*CJOJQJaJhA>.h$TCJOJQJaJhA>.hnCJOJQJaJhA>.h;CJOJQJaJ.o$$%q%%%''))0+1+I,J,6.7.f/g/o1 h^h`gdA>.gdA>. >^`>gdnh^hgd; >^`>gd$Th^hgd$T^gd$T^gdA>.`gdA>.`gdgR,,,,--.../7/e/f/0n1p1q1r1t1}111111111111222232R2S2T2U2W2`2d222ѳѳ}Ѥ}nѳѤhA>.h&CJOJQJaJh(OCJOJQJaJhA>.h=CJOJQJaJh=CJOJQJaJhA>.h;CJOJQJaJhA>.h$TCJOJQJaJhA>.hweyCJOJQJaJhA>.h CJOJQJaJhA>.hnCJOJQJaJhA>.hn6CJOJQJaJ+o1p1132R2S2222A3o3p3444R5S5]5n5o5p55gdM h^h`gdA>.h`hgd_gd_gdA>.gd$Th^hgd;h`hgd(Ogd(OgdgR2222222@3A3n3o34444 5.5ôxhXH9*hA>.h~;lCJOJQJaJhA>.h`CJOJQJaJhA>.h`5CJOJQJaJhA>.hM5CJOJQJaJhA>.h;5CJOJQJaJhA>.h CJOJQJaJh_h$TCJaJh_CJaJh_h_CJaJh_h_CJOJQJaJh_h$TCJOJQJaJh_h CJOJQJaJhA>.h$TCJOJQJaJhA>.h$T5CJOJQJaJhA>.h;CJOJQJaJ.5S5\5]5m5n5555X6\6]666777!7)7L7M7N7O7P7::񲥲|l]WSOh@}lh` h`CJhA>.hlCJOJQJaJhA>.h\J>*CJOJQJaJhA>.hk>*CJOJQJaJh!wa>*CJOJQJaJh[CJOJQJaJh[>*CJOJQJaJhA>.h\JCJOJQJaJhA>.h`5CJOJQJaJhA>.h*]z5CJOJQJaJhA>.hwey5CJOJQJaJhA>.h`CJOJQJaJ5555666Q6X6]6666777M7N7P7Q7::gd!wa p^p`gdA>.$a$.:pA>./ =!"#$% s2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH 8`8 eNormal_HmH sH tH <@< e Heading 1 $@&a$CJDA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List hh ^~~ Medium Grid 1 - Accent 2 ^CJOJPJQJaJHH 4` Balloon TextCJOJQJ^JaJN/N 4`Balloon Text CharCJOJQJ^JaJB' !B  }Comment ReferenceCJaJ424  } Comment Text:A:  }Comment Text Char@j12@  }Comment Subject5\F/aF  }Comment Subject Char5\PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< 2Vt u#,2.5: !#$&()!o$o15:"%'*L# @0(  B S  ?2rv z "/ ##))**A+I+23333333333--///!/22R.yv˚Td נNb! , $IRtc: ~Q5Z8l&"<6_z/D24pJaLNh}NS[T6Tm&W{Y)JizYD ^^4c tt@Z ~2dV ^`OJQJo( 8^8`OJQJo( ^`OJQJo(o  p^ `OJQJo(  @ ^ `OJQJo( x^x`OJQJo( H^H`OJQJo(o ^`OJQJo( ^`OJQJo(^`OJPJQJ^Jo(hH ^`hH. pp^p`hH. @ @ ^@ `hH. ^`hH. ^`hH. ^`hH. ^`hH. PP^P`hH.@hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. h ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.@hh^h`56>*CJOJQJo(. h ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.80^8`0o(. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(.  ^`hH. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.@hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. @h!h^h`56>*B*CJOJQJo(ph. @hh^h`56>*CJOJQJo(. @hh^h`56>*CJOJQJo(. tcTd 2T{YJm&Wz/D4c^^&"<izYtb! LN ~.y .y, Q5Z8NS QdExRon Sd="T" PUty=SemWen=:                                           d0)G$M f5SXE|%~ 6B} N +* ` g ~s W o /v5xqV6-!G002s:h_kU9X%pm*! !"GW$]$(H)?*/+%+,#,-.A>.7`/F1Q2~3;6RH8K9;7=5f=EVtF!LG4H,oJWK^KON(OQOW,QdQgR$T HTWXWf-YQY;\+V\]~^lz_4``!wa^cK\deL/iIiYQiVjly7l~;l@}lAm-H~~t[KRUIe+o&j?sO(jO{HHRIw1} Gz|sn_\Jiuz &BY2I$z?@ABCDEFGHIKLMNOPQSTUVWXY\Root Entry F0%op^1Table,R;WordDocument0VSummaryInformation(JDocumentSummaryInformation8RCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q