AA-000-Instructions for Educational Experience Affiliation Agreement Form

AA-000-Instructions for Educational Experience Affiliation Agreement Form

(EEAA)

1)  TAB to first field within the first paragraph and begin typing.

a.  Enter the 1st day of Month and Year that agreement will be effective (ex. 1st day of September 2013).

b.  TAB to second field and enter the full name of the facility (include DBA if applicable)

c.  TAB to third field and enter the full facility address (street, ste #, city, state and zip code)

2)  TAB to second paragraph and begin typing.

a.  Enter the city of the facility.

b.  Tab to next field and enter the state of the facility.

3)  TAB to next field (Page 3, Section 11) and enter the termination date of the agreement. NOTE: The agreement may be in effect for five years (negotiable) and the termination date will be the day prior to the effective date (ex: 1st day of September 2013 and expires August 31, 2018).

4)  TAB to the last field (Page 4).

a.  Enter the full Facility name in Capital letters (include DBA if applicable)

5)  Save document to your file to upload into IRBNet.

Instructions for Program Agreement Form (PA)

1.  Field is ready for first entry.

a.  Enter the full name of the Program in CAPITAL letters (ex. PHYSICAL THERAPY)

2.  TAB to first paragraph and enter the full name of the facility (include DBA if applicable).

3.  TAB to next field in the second paragraph and enter the full name of the College (ex: College of Health Sciences, School of Nursing, etc.)

4.  TAB to the next field (Section 1) and enter the full name of the degree program (ex: Physical Therapy, Social Work, etc.)

5.  TAB to the next field (Page 3, Section 4.e.)

a.  Enter the effective date of the PA (this will be the same date entered in the EEAA)

b.  TAB and enter the termination date (this is the same date as entered in the EEAA)

6.  TAB to last field and enter the full facility name in CAPITAL letters (include DBA if applicable).

a.  Save document to your file and upload into IRBNet.

If you need further assistance, please call extension 5401 or 8841 and we can walk you through the process.

ORSP-AA-Forms Instruction Page 08-14-13