OSU-HDFS/Human Services Program

Affiliation Agreement

OSU-HDFS/Human Services Program

THIS AGREEMENT is between the Oregon State University for its College of Public Health and Human Sciences (“OSU”) and […………………………………….] (“AFFILIATE”).[…………………………………….] OSU and AFFILIATE may be referred to individually as a “Party” or collectively as “the Parties.”

WHEREAS, OSU desires to work with AFFILIATE for the provision of experiential educational opportunities in the field of Human Services required for Students enrolled in OSU’s Human Development and Family Sciences/Human Services option degree program (the “Student”); and

WHEREAS, AFFILIATE agrees to provide Students opportunities demonstrating professionalism in the workplace, drawing connections with historical and theoretical foundations of the field, exposure to and practice in the delivery of direct service skills with individuals, families, groups and/or communities, information management, program assessment, design and evaluation, administrative functions, development of interpersonal skills, social and economic inequities, and reflective use of self in the helping relationship (the “Field Education”); and

NOW THEREFORE, in consideration of the mutual agreements set forth herein, OSU and

AFFILIATE agree:

1. OSU agrees to:

1. Refer to AFFILIATE only those Students who have satisfactorily completed the prerequisite portion of the curriculum and are appropriately qualified to participate in the educational program.

1. Advise OSU personnel and Students to comply with the policies and procedures of AFFILIATE, applicable laws and regulations, and the standards and accreditation requirements of any accrediting body responsible for accrediting AFFILIATE. OSU shall promptly notify AFFILIATE if it receives notice of any actual or alleged infraction, violation, default or breach of the same.

1. Advise OSU personnel and Students that they shall be required to understand and comply with all AFFILIATE policies/procedures regarding confidentiality or client information.

1. Advise Students of their responsibility to maintain and provide to AFFILIATE a current health record showing the student’s physical status, current immunizations, and exposures.

1. Advise Students that placement with AFFILIATE may be contingent upon Student meeting additional requirements, ie. Criminal background checks, drug screens, etc., and that any costs to complete such requirements will be the responsibility of the Student unless otherwise specified by the AFFILIATE.

1. Maintain all educational progress records of Students.

1. Designate an OSU employee to plan and coordinate the Student’s educational program with AFFILIATE and act as liaison for AFFILIATE, OSU and the student(s).

1. Provide to AFFILIATE the HDFS Human Services Field Education Program Handbook (the “Field Education Handbook”) which shall be the primary resource for the learning objectives and the Field Education program. The Field Education Handbook is incorporated to this Agreement by this reference.

B.AFFILIATE agrees to:

1.Identify a designated staff member to coordinate the administrative aspects of working with the Student and OSU to arrange the placement with Affiliate.

2.Provide a designated staff member to act as the student’s Mentor.

3.Provide to Student orientation and training on AFFILIATE policies and procedures at the beginning of placement with Affiliate. Said policies and procedures should specifically address incident prevention, incident reporting, and incident response/trauma management as addressed in the Field Education Handbook. Training shall include hazard awareness, violence and injury prevention, to include precautions and controls to minimize exposure to pathogens or toxic substances, and general safety protocols.

4.Serve as the primary oversight of the Student placement to ensure the learning activities are consistent with guidelines in the Field Education Handbook and each student’s Field Learning Plan & Evaluation Tool.

5.Provide for Student’s safety while under the supervision of AFFILIATE. AFFILIATE is responsible for determining and supervising situations where Students’ safety may be jeopardized and ensure that Students are not to, under any circumstances, (a) be present at a client’s home without Affiliate staff present; (b) be in any vehicle with a client without AFFILIATE staff present; or (c) transport a client in their personal vehicle.

6.Provide the Student with regular individual, face-to-face supervision according to the guidelines specified in the Field Education Handbook and as mutually agreed upon by the Parties.

7.Evaluate the performance of the Student(s) in writing, using forms and/or format provided or approved by OSU.

8.Permit, upon reasonable written notice allowing priority to client care related issues and confidentiality, access to view the Training Site by Internship Coordinator, OSU Field Liaison or other HDFS faculty for the purpose of strengthening mutual familiarity and understanding.

9.Provide the workspace, office supplies, equipment (hardware and software), and administrative support reasonably necessary for the Student to effectively complete requirements of the Student’s Field Education experience.

10.AFFILIATE will advise OSU in a timely manner of any serious deficiency noted in a Student’s performance. The Parties will work with the Student to devise a plan by which the Student may be assisted toward achieving the stated objectives of the Field Education or be released by the AFFILIATE.

11.AFFLIATE shall provide sufficient personnel to provide its services independent of Students. Services rendered by Students under this Agreement are considered educational in nature with the primary focus being the professional training of the Student, rather than productivity or performance as is the case of AFFILIATE employees or non-student volunteers. Clerical and housekeeping activities should be kept to a minimum.

12.With regard to a Student who is employed by the Affiliate while also completing their Field Education program for academic credit presents a situation with particular challenges. The priority focus must remain on the student as learner, in accordance with the Learning Plan. OSU must be informed of this scenario prior to the Student starting their Field Education placement, or as soon as a decision is made to hire.

C.Mutual Responsibilities of the Parties

1. Read and abide by the guidelines set forth in the Field Education Handbook and as mutually agreed by the Parties.

1. Maintain regular communication to support the Student’s Field Education experience. Discuss matters of mutual concern including the quality of programs and plans, problems, and changes related to the Student. The Parties agree to communicate about any incident(s) that involve Students' safety as referenced in the Critical Incident Protocol section of the Field Education Handbook or any serious deficiency in the Student’s performance.

1. Cooperate in placement of Students. AFFILIATE has the final decision on the number of Students it can accommodate, and the procedures by which AFFILIATE will screen and select Students.

1. General Provisions

1. Term. This Agreement shall be effective as of the date of last signature and continue, unless otherwise terminated for a period of three (3) years. If the Parties mutually agree, the term of this Agreement may be extended for one additional three (3) year period. Such extension of terms shall be made by written amendment and become effective upon execution by both Parties.

1. Termination.

a)Either Party may terminate this Agreement without cause by giving the other Party written notice at least thirty (30) days prior to the effective date of such termination; provided, however, that Students placed with AFFILIATE at the time of the notice shall be given the opportunity to complete the current term of the program in which they are participating.

b)AFFILIATE shall have the right to terminate this Agreement without notice if AFFILIATE determines that continuation of this Agreement or the Field Experience may: (a) have a detrimental effect on AFFILIATE’s professional staff, patients, or clinical operations; (b) expose AFFILIATE to any type of legal liability; or (c) interfere with AFFILIATE’s primary mission of providing health care services to its patients.

c)Student has the option to terminate the Field Experience if it becomes unreasonable for the AFFILIATE to provide sufficient opportunities for the Student to meet her/his goals, the. The decision for this termination shall be made by mutual agreement between the Student and the Internship Coordinator. Termination procedures are outlined in the Field Education Handbook .

1. Non-Discrimination. The Parties shall not discriminate against any employee, applicant, client, or student enrolled in their respective programs because of race, color, religion, gender, gender identity or expression, age, national origin, disability, sexual orientation, military service, or political affiliation.

1. Criminal Background Checks and Medical/Health Clearances. OSU does not perform background checks or medical or health checks on Students for placement in Field Education programs, and OSU does not certify or vouch for the background or the health of the Students recommended for placement with AFFILIATE. Accordingly, if AFFILIATE requires Students to pass a background or medical/health check prior to placement at their site, AFFILIATE may conduct background/medical/health check on the Student, or require the Student to obtain a background/medical/health check and submit the results to AFFILIATE. It shall be AFFILIATE’s responsibility to evaluate the results of such background check and determine the Student’s fitness for duty.

1. Compensation. The Parties agree no monies will be paid by either Party to the other under the terms and conditions of this Agreement and the mutual benefits contained herein accruing constitute sufficient consideration.

1. Student Status. Services rendered by students under this Agreement are considered educational in nature and Students shall not be considered employees or agents of OSU. None of the benefits provided by AFFILIATE to its employees including, but not limited to, workers’ compensation insurance and unemployment insurance shall be provided by AFFILIATE to OSU or any employees, agents, servants or contractors of OSU, including Students. If AFFILIATE intends to pay the Student while engaged in Field Education program, a separate agreement must be in place between the Student and the AFFILIATE.

1. Applicable Law. The Parties agree to comply with all federal, state, county, and local laws, ordinances, and regulations, applicable to the work to be done under this Agreement. Both Parties agree to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. This Agreement shall be governed and construed in accordance with the laws of the State of Oregon.

1. Indemnification.

a)AFFILIATE shall defend, indemnify, and hold harmless OSU and its board members, officers, employees, and agents from all claims, suits, and actions of whatsoever nature resulting from or arising out of the negligent activities of AFFILIATE or its subcontractors, board members, officers, employees, and agents acting under this Agreement.

b)If the AFFILIATE is a public entity, subject to the limitations and conditions of the Oregon Tort Claims Act, ORS 30.260-30.300, and the Oregon Constitution, Article XI, section 7, each Party shall save, indemnify and hold harmless the other Party and their officers, agents, employees, and board members from all claims, suits, and actions of whatever nature resulting from or arising out of the negligent activities of the indemnifying Party or its board members, officers, agents, employees acting under this Agreement.

c)A Party’s right to receive indemnification under this section is conditioned upon: (i) the Party giving the Indemnified Party reasonably prompt Notice after the giving Party receives notice of any claim; (ii) the Indemnified Party being given the opportunity, at its option, to participate and associate in control and defense of the claim and any related settlement negotiations, and (iii) the giving Party giving Indemnified Party full cooperation in the defense of such claim

1. Relationship of the Parties. For the purposes of this Agreement and all services to be provided hereunder, each Party will be, and will be deemed to be, an independent contractor and not an agent, partner, joint venturer, or employee of the other Party. Neither Party will have authority to make any statements, representations or commitments of any kind or to take any actions that are binding on the other Party, except as explicitly provided for herein or authorized in writing. Nothing contained in this Agreement shall be deemed to create any agency, partnership, joint venture or similar relationship.

1. FERPA. Both Parties recognize that they are bound to comply with the Family Educational Rights and Privacy Act (Buckley Amendment) (“FERPA”) in the handling of educational records. The Parties recognize that they are not permitted to authorize any further disclosure of educational records of Students of the other Party to persons or entities not Party to this Agreement without first having received permission of the other Party and having obtained assurances that the other Party has fully complied with the provisions of FERPA.

1. HIPAA. The Parties understand and agree that HIPAA compliance with respect to clients treated by students under this Agreement is AFFILIATE’s obligation, and that OSU will have no relationship with clients that would trigger HIPAA compliance requirements. Further, the Parties understand and agree that OSU will not be receiving any protected health information or confidential information in the course of performance of this Agreement that would require a business associate agreement under HIPAA.

1. AFFILIATE shall, through self-insurance or a commercial policy, keep in effect during the term of this Agreement Automobile Liability Insurance (if motor vehicles are used in performance of this Agreement) with minimum limits of $1,000,000 combined single limit; Professional Liability with minimum limits of $1,000,000 per claim and $3,000,000 aggregate; and General Liability Insurance with minimum limits of $1,000,000 per occurrence and $2,000,000 aggregate for bodily injury, personal injury and property damage.

1. OSU is self-insured under ORS 352.087 with adequate levels of excess general liability and commercial auto liability insurance and maintains workers’ compensation insurance for its employees in conformance with ORS Chapter 656.017, subject to the Oregon Tort Claims Act (ORS 30.260 – 30.300). A certificate of insurance will be provided upon request. OSU does not waive the right to subrogation.

1. OSU shall require each Student to have professional liability insurance on an occurrence basis, with primary limits of not less than $1,000,000 /$3,000,000. A certificate of student’s insurance status shall be provided to AFFILIATE upon request. Students are encouraged to carry their own personal health/medical insurance coverage and may be required by to provide evidence of such coverage to AFFILIATE prior to placement.

1. Each Party warrants that it possesses the legal authority to enter into this Agreement and that it has taken all actions required by its procedures, by-laws, and/or applicable laws to exercise that authority, and to lawfully authorize its undersigned signatory to execute this Agreement and to bind such Party to its terms. The person(s) executing this Agreement on behalf of each Party warrants that such person has full authorization to execute this Agreement.

1. Merger. This Agreement constitutes the entire agreement between the Parties. There are no understandings, agreements or representations, oral or written, not specified herein regarding this Agreement. No waiver, consent, modification or change of terms of this Agreement shall bind either Party unless in writing and signed by all Parties. Any such waiver, consent, modification or change shall be effective only in the specific instance and for the specific purpose given. Neither Party shall be accorded any advantage over the other by reason of being the drafter of the language of this Agreement.

WHEREFORE, the Parties have entered into this Agreement as of the date last set forth below:

OREGON STATE UNIVERSITY
Signed:
Karen Hooker, School Head
School of Social & Behavioral Health Sciences
T: 541-737-4336

Date:
Signed:
OSU Contracts Officer
Contract Services | PCMM | Business Affairs
Oregon State University
644 SW 13th Street
Corvallis, OR 97333
T: 541.737.4261
F: 541.737.5546

Date: / AFFILIATE
Signed:
Printed Name
______
Title
Date:
Affiliate’s Mailing Address:
______
______
______
Affiliate’s Phone:
______
Affiliate’s Email:
______

Page 1 of 7

HDFS OSU-CORVALLIS

VERSION DATED 5.9.17