Fillable GHTM Affliation Agreement 2018 2019 Per GC (University of West Florida)

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GHTM Affliation Agreement 2018 2019 Per GC (University of West Florida)

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OGC Approved Non-Clinical Student Internship Agreement FALL-2018
1
STUDENT INTERNSHIP AGREEMENTS
FOR UWF STUDENTS WORKING IN OUTSIDE NON-CLINICAL AGENCIES
AGREEMENT GUIDELINES AND STUDENT INTERNSHIP AGREEMENT
FORM A
____________________________________________________________________________
Introduction
I
n an effort to provide UWF students with hands-on experiences outside the classroom that are consistent
with the goals and objectives of the curriculum, students are placed in learning experiences at external
agencies such as health care facilities, social service agencies, and other businesses. Learning
experiences typically are unpaid and are part of a student’s course requirement. The rights and
responsibilities of the University and the site are implemented through a student internship agreement.
The following items are intended to provide assistance to University departments as they go through the
process.
Student Internship Agreement
1. U
nder the Heading and under Section I. - Please make sure that the Department is identified in th
e
bl
ank space provided. The agreement needs to indicate which Department is accepting responsibility
for administering the agreement within the University. Example: “Department of Political Science.”
2. U
nder Section I. Parties – Please make sure that the Agency is identified in the blank space
provided. The agreement needs to indicate which outside entity or “Agency” is accepting
responsibility for administering the student internship experience. Example: “Escambia County
Board of County Commissioners.”
3. U
nder Section III. Term – Contracts will not take legal effect until all parties have signed th
e
doc
ument. This is of critical importance because if you are operating for some period of time befor
e
t
he contract is fully signed (“executed”) you (and the University) are operating without the protectio
n
of
a legally binding contract. Therefore, student internship agreements should be fully execute
d
(
signed) before a student is placed in a site.
4. Under Section V. Mutual Responsibilities – Please make sure that the Department, the minimum
t
otal hours and the hours per week are identifiable in the blank space provided
.
5. U
nder Section VIII. Coordinators – Please make sure that the Agency’s liaison and contact
information and the University Department, Bldg. and Room are identified in the spaces provided.
6. M
onetary compensation to students may or may not be provided under the terms set out in the Student
Internship Agreement. If monetary compensation is provided, the Agreement provides that the party
making payments shall be responsible for the applicable payroll, accounting, tax withholding, worker’s
compensation insurance and unemployment benefits.”
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
2
7. Students do not
sign student internship agreements. The student internship agreement clarifies the
responsibilities of the University and the Agency. Students do not have the authority to bind the
University and are not parties to this Agreement. (NOTE: Please do not place the responsibility for
getting this agreement completed upon your student(s). This is something that should be handled by
the Associate/Assistant Dean or Placement Coordinator).
8. The University’s student internship agreements are located at the Office of the General Counsel’s
website at https://uwf.edu/offices/general-counsel/office-of-general-counsel/forms/. As long as you
use the current student internship learning agreement or clinical student internship agreement with no
additions or deletions, review of the agreement by the Office of the General Counsel is not necessary.
However, if the Agency recommends changes to the University’s student internship agreement, those
changes must be reviewed by the Office of the General Counsel if the changes are to a key areas of
emphasis, i.e. indemnification, choice of law and venue, anti-discrimination, FERPA or GDPR and
insurance provisions, if any.
9. If an Agency requires use of its own agreement instead of the University’s student internship
agreement, review of the agreement is required by the Office of the General Counsel the first time that
the form is used. Thereafter, it need not be reviewed and approved by Counsel again unless it is
altered or amended.
10. Signature Process. Typically, the Placement Coordinator forwards the agreement to the internship site
representative for signature via DocuSign. This should be handled directly by the Associate/Assistant
Dean and the Placement Coordinator. When the agreement is returned, it is signed by the Dean and
Chair via DocuSign. On the signature page, the left-hand column is for the Dean’s and Chair’s
signature and the right-hand column is for the external agency representative’s signature. Students do
not sign the experiential learning agreement.
11. During the process of submitting the agreement through DocuSign, the Associate/Assistant Dean
or Placement Coordinator, must send a copy of the final signed Agreement to the Provost’s
office through DocuSign using the internagreements@uwf.edu e-mail address. The Student may
not begin the internship unless or until the signed agreement is submitted to the Provost’s office.
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
3
UNI
VERSITY OF WEST FLORIDA
Department of _______________________________________________
S
TUDENT INTERNSHIP AGREEMENT
I.
Parties
This Student Internship Agreement ("Agreement") is made and entered into as of the date last signed below
between The University of West Florida , Department of ____________________, acting for and on behalf
of the University of West Florida Board of Trustees, a public body corporate (hereinafter "University") and
____________________________________________________________________________________
(hereinafter referred to as "Agency"), (collectively, the “Parties”).
II.
Purpose of Agreement
I
t is mutually agreed that the purpose of this Agreement is to provide a comprehensive learning experience
for participating students from the University within a professional setting in accordance with the guidelines
set forth in this Agreement and any attached addenda. This Agreement confirms the mutually agreed terms
and conditions of supervised learning experiences to be performed at the Agency.
III.
Term
A. The term of this Agreement shall commence on the date upon which the last signature is affixed
hereto and will automatically renew annually unless either party provides at least ninety (90) days
written notice of its intent to terminate prior to the expiration of the then current annual term.
B. T
his Agreement may be terminated by either party upon written notice of at least ninety (90) days.
In the event of a termination, the Parties should use their best efforts to ensure that the termination
will not negatively affect students currently placed at the Agency
.
I
V. Compliance with UWF and Agency Policies
A. S
tudents working for the Agency will be subject to the UWF Student Code of Conduct, copies of
which will be provided to the Agency by the UWF Placement Coordinator. If alleged violations
occur, the Agency will notify the UWF Placement Coordinator (“University Coordinator”). If such
al
leged violations reasonably seem to pose a continuous threat to others, the alleged violator may
be suspended immediately by the Agency from participating in the Agency’s activities.
B. A
gency reserves the right to request the University to withdraw any Student from its facilities whose
conduct or work with patients or personnel is not in accordance with the policies and procedures of
the Agency. In such event, the Student’s participation in the program at the Agency shall
immediately cease. It is understood that only the University can dismiss a Student from the
Program. Agency will advise the University at the earliest possible time of any deficit noted in a
Student's ability to progress toward achievement of the stated objectives of the experience. Agency
shall provide an orientation session/materials for Students and shall assure that all Students are
made aware of those actions which may result in dismissal for cause.
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
4
C. T
he Agency may also require the student(s) participating in the Agency’s activities to comply wit
h
i
ts own operational policies and procedures.
V.
Mutual Responsibilities
A. Educational Program.
1. T
he Parties agree to provide a comprehensive learning experience within a professional setting (the
“Program”) for students enrolled in the University’s ____________________________________
program (“Students”). Student participation in the Program will require a minimum of __________
total hours (____ credit hours) requiring approximately __________ hours per week depending on
the needs of the Agency and opportunities for the Students.
2. T
he Parties agree that the Students selected for the program will be permitted to participate at date
s
an
d times mutually agreeable between the Agency and the University. The number of Students
and specific dates when the Students will be utilizing the various departments of the Agency will
be established and agreed upon by both parties in advance of the specific session.
3. T
he Parties agree to work together to maintain an environment that provides quality student
learning within the curriculum plan of the Program. Agency and University shall be mutually
responsible for the assignment for Students taking part in the Program based upon the goals a
nd
objectives of the Program.
4. T
he Parties shall ensure Student participation shall complement, rather than displace, the work of
paid employees of the Agency.
B. Non-Discrimination/Harassment. The parties agree to continue their respective policies of
nondiscrimination and harassment based on age, color, disability, gender, gender identity, sex,
sexual orientation, marital status, national origin, race, religion, and veteran status. Each party shall
be responsible for their compliance with applicable state and federal laws, rules and regulations
prohibiting discrimination and/or harassment
.
C. Non-Disclosure. The University may disclose information from a Student's educational record and
personal data, as appropriate, to personnel at the Agency who have a legitimate need to know in
a
ccordance with the Family Educational Rights and Privacy Act of 1974, as amended (20 U.S.C
.
1232g
; 34 CFR Part 99) and the European Union General Data Protection Regulation. The
Agency hereby agrees that its personnel will use such information only in furtherance of the
Program for the Student, and that the information will not be disclosed to any other party without
notice to the University and with the Student's prior written consent. For the purposes of this
Agreement, the University hereby designates Agency as a school official with a legitimat
e
e
ducational interest in the educational records of the participating Student(s) to the extent that
access to the Student’s records is required by Agency to carry out the Program. Records of
University and Agency will be subject to public access only to the extent required by Chapter 1
19,
F
lorida Statutes
.
D. Assumption of Risk. Each party assumes any and all risk of personal injury and property damage
attributable to the negligent acts or omissions of that party and its own officers, employees and
a
gents while acting within the course and scope of their employment or agency. Nothing containe
d
i
n this Agreement shall be construed or interpreted as denying the University or other state entity
any remedy or defense available under the laws of the State of Florida; the consent of the University
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
5
t
o be sued; or a waiver of sovereign immunity of the University beyond the waiver provided in
section 768.28, Florida Statutes (2018).
V
I
.
Specific Responsibilities of the University
A. Coordinator. University shall designate a person or persons to coordinate and act as liaison with the
appropriate Agency personnel. University shall provide to Agency the current curriculum, course
objections, and any syllabus of University’s applicable educational Program, as well as all form
s
r
egarding practicum experience and instructions for completion of these forms. The University shall
provide one or more faculty who will be responsible for instruction of the students while
participating in the Program and for evaluation of each such student. The University faculty has
the responsibility of selecting, planning, and evaluating the work of the Students and for providing
the Agency with necessary forms and information relating to the Program
.
B. Approve the placement site and learning objectives.
C. Select and register students for placement.
D. Student List. University shall provide the Agency with a list of Students participating in the learning
experience at least ten (10) days before each program is to start. There is no minimum number of
Students required to be placed at the Agency
.
E. Implement procedures to notify students of obligations listed below:
1. Attend orientation sessions regarding learning activity;
2. Comply with all applicable policies and operational procedures of the Agency
3. Give prior notice of necessary absence to appropriate UWF and Agency personnel;
4. Obtain and maintain any required professional personal liability and/or health insurance;
5. Maintain professional standards of confidentiality; and
6. Participate in all individual or group meetings associated with learning activity.
F. Attendance. University shall instruct each Student to attend all educational activities and adhere to
applicable attendance policies of Agency where Student may be assigned. The University shall also
inform the Agency of the UWF academic calendar and initiate discussion of the students’ obligations
to report to the Agency whenever classes are not in session.
G. Student Progress. University agrees to communicate with the Agency's coordinator and Student to
assess Student's progress as necessary.
VII
. Specific Responsibilities of the Agency
It shall be the responsibility of the Agency to:
A. Orientation. Provide an appropriate orientation to Students concerning the facilities and the rules,
policies and procedures of the Agency and other related material, such as scheduling information.
B. Educational Experience. The Agency agrees to provide to University Coordinator a list of duties or
job descriptions for student placements with notation of any specific prerequisite skills or abilities.
The Agency agrees to provide professional facilities and services for Students in accordance with
the objectives of the program and assist in the evaluation of Student's learning experience. The
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
6
A
gency agrees to participate in planning and evaluation sessions with Students and, where
appropriate, with University faculty. The Agency agrees to provide on-site supervision of Students
relating to the educational experience. The Agency agrees to provide timely evaluation of student
performance in the manner specified by the University and conduct exit interviews with Students
that will include discussion of the Agency's evaluation of the Student.
C. P
rovide a safe environment in compliance with all federal and state laws and inform UWF and
students of hazardous conditions and unusual circumstances that may create unsafe conditions.
D. P
rovide to the University Coordinator and students written policies and operational procedures to
which students are expected to adhere while they are at Affiliation setting.
E. N
otify the University Coordinator of unsatisfactory performance or misconduct of a student and
provide related documentation to the coordinator. If a student fails to comply with Affiliate’s
policies and procedures, the Agency may immediately suspend or terminate that student from
further participating in the program on its premises.
F. Coordinator. Designate a coordinator or preceptor from its staff to act as the liaison with University
in this Agreement. The Agency Coordinator has the responsibility of selecting, planning, and
evaluating the work of the students and such selecting, planning and evaluating shall b
e
acco
mplished in accordance and consistent with the policies and programs of the University
Coordinator
.
VIII
.
C
OORDINATORS. University and Agency shall designate a person (or persons) to coordinate and
act as preceptor or liaison with the other party as set forth below:
Agency: University:
_______________________ University of West Florida
_______________________ Department of ___________
_______________________ 11000 University Parkway
_______________________ Building ___/Room ____
_______________________ Pensacola, FL 32514
Attn: ___________________ Attn: Program Coordinator
IX
.
Specific Responsibilities of Students
University agrees to advise each Student assigned under this Agreement to:
A. Compliance. Comply with the UWF Student Code of Conduct, policies and procedures of the
University and Agency, and with all state, local and federal regulations.
B. Uniform. Provide and wear any necessary and appropriate uniform while on duty with the Agency.
C. Transportation. Arrange for all transportation requirements for participation in the Program.
X.
Mutual Terms and Conditions
A. Independent Contractors. The relationship of the Parties hereunder shall be an independent
contractor relationship, and not an agency, employment, joint venture, or partnership relationship. Neither
party shall have the power to bind the other party or contract in the name of the other party. All persons
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
7
e
mployed by a party in connection with operations under this Agreement shall be considered employees of
that party and shall in no way, either directly or indirectly, be considered employees or agents of the other
party.
B. Conflicts. Both parties agree that in the event conflicts or problems arise related to the participation
of any Student pursuant to this Agreement, Agency shall immediately contact University’s Coordinator. In
the event that disagreements are not resolved by the Student involved, and the coordinators, such
disagreements shall be resolved by the Chairperson of the Department at the University and the chief
executive officer of Agency or his/her designee
.
C. Integration. This Agreement, together with any applicable Addenda, represents the entire
understanding and agreement between the parties with respect to the subject matter hereof, and supersedes
all negotiations, understandings and representations (if any) made by and between such parties. The terms
and provisions hereof may be amended, supplemented, waived or changed by a writing signed by each of
the parties heret
o.
D. Governing Law. This Agreement shall be construed and enforced in accordance with the laws of
the State of Florida and any disputes shall be filed in a Florida court of competent jurisdiction.
E. Severability. If any provision of this Agreement is held to be illegal, invalid or unenforceable under
present or future laws effective during the term of this Agreement, the legality, validity and enforceability
of
the remaining provisions shall not be affected thereby
.
F. Assignment. This Agreement may not be assigned, in whole or in part, by either party without the
prior written consent of the other party.
G. Electronic copies. This Agreement may be executed by electronic or facsimile means and in
counterparts, each of which shall be deemed an original and all of which together shall constitute one and
the same instrument
.
X
I
.
Special Additional Conditions Where Agency is a Private “For-Profit” Entity
Se
e U.S. D.O.L. Fact Sheet #71 Internship Programs Under the Fair Labor Standards Act April 2010)
Wh
ere the Agency is a private, “for-profit” entity, and it is contemplated that the Student will not be
compensated in compliance with the wage and hour provisions of the Fair Labor Standards Act (e.g., at
least minimum hourly wage, time and a half for overtime, etc.), then Agency agrees that the placement will
have the following characteristics:
1. T
he placement, even though it may include actual operation of the facilities of the Agency, is similar
to training which would be given in an educational environment;
2. The placement experience benefits the student;
3. The student does not displace regular employees, but works under close supervision of existing
staff;
4. The Agency derives no immediate advantage from the activities of the student; and on occasion its
operations may actually be impeded;
5. The student is not necessarily entitled to a job at the conclusion of the placement; and
OGC Approved Non-Clinical Student Internship Agreement FALL-2018
8
6. T
he Agency and the student understand that the student is not entitled to wages for the time spent
in the placement.
XII. Number of Placements
A
gency and UWF will mutually determine the number of students to be placed at Agency for a given term.
Agency and UWF may decide to have no active placements for a period of time without affecting the
continuation of this Agreement.
XII
I. Monetary Compensation to Student
W
hile not required, monetary compensation may be provided to students placed in learning activities under
this Agreement by either Agency or by the University. Accounting for such compensation and for any
applicable taxes and benefits will be the responsibility of the party providing such compensation to the
student.
XIV. Employment
S
tudents are not considered employees or agents of either UWF or Agency. Rather, Students are considered
to be independent contractors for purposes of this Agreement.
X
V
.
Entire Agreement
T
his Agreement represents the entire agreement between the Parties and may not be modified without the
written consent of both parties. In witness whereof, the parties hereto have caused this Agreement to be
signed by their respective authorized representatives.
IN WITNESS WHEREOF, the Parties have executed this Agreement by their duly authorized
representatives.
Th
e University of West Florida Agency
By: _____________________________ By: ______________________________
Signature Signature
Print Name: _______________________ Print Name: _______________________
Title: Dean of College of ____________ Title: ____________________________
Date: ____________________________ Date: ____________________________
B
y: _______________________________
Signature
Print Name: ________________________
Title: Chair of UWF Dept. of __________
Date: ______________________________
Not final until a signed and executed copy of this Agreement is submitted to the
Provost’s office through DocuSign using the internagreements@uwf.edu e-mail
address.
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GHTM Affliation Agreement 2018 2019 Per GC (University of West Florida)

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Completed 25 July 2020

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