MEMORANDUM OF AGREEMENT
AFFILIATION FOR CLINICAL EDUCATION
WHEREAS, The Board of Trustees of The University of Alabama for The University of
Alabama at Birmingham (hereinafter referred to as “University”) and Company, (hereinafter
referred to as “Facility”) desires to set out in writing the terms and respective responsibilities of
the two institutions for the clinical education of students in the School/Department, etc.,
(hereinafter referred to as “School/Dept”).
The University and the Facility agree as follows:
A. Facility Responsibilities:
1. To provide instruction and supervision appropriate for the student’s level of
preparation and continued learning. However, it is understood that students shall not
be used in lieu of professional or staff personnel and shall be under appropriate
supervision at all times.
2. To share in the responsibility for the education of School/Dept students through the
cooperation and assistance of its staff and employees along with the faculty of the
University. Only those employees who are qualified by education, experience and/or
professional credentials may serve as clinical/adjunct faculty.
3. To maintain accreditation status by the appropriate accrediting agency.
4. To make available first aid and emergency care for illnesses or accidents occurring
on the premises. All other medical and dental costs are the responsibility of the
5. To maintain records and reports on each student’s performance and provide a
written evaluation of each student’s performance to the University.
6. To request withdrawal or dismissal of any student whose performance record or
conduct does not justify continuance in clinical education at this Facility.
7. To orient the student to the Facility and its rules and regulations.
B. University Responsibilities:
1. To send the Facility only such students who have successfully completed the
requirements for the clinical education component of the curriculum.
2. To take action regarding any student whose performance record or conduct does
not justify continuance in clinical education at the Facility.
3. To support rules and regulations governing students that are mutually agreed upon
between the University and the Facility.
4. To designate a faculty member to coordinate and act as the contact person with a
designee of the Facility.
5. To assign students to clinical education only when mutually arranged by the
University and the Facility.
6. To maintain channels of communication for exchange of information with clinical
faculty by on-site visits when practical and by telephone in other instances.
7. To provide proof of insurance for students while on clinical assignment.
C. Student Responsibilities:
1. To follow the administrative policies, standards and practices of the Facility.
2. To be responsible for transportation and living arrangements when not provided by
3. To be prepared to present proof of enrollment in an acceptable hospitalization plan
upon arrival at the Facility.
D. Terms of Agreement:
1. This Agreement shall become effective (DATE) and continue indefinitely. This
Agreement shall be reviewed by both parties annually hereto and shall automatically
renew itself for a period of one year unless either party desires to terminate the
Agreement and gives the other party one hundred and eighty days notice of intention
2. The Facility and UAB agree that there shall be no discrimination on the basis of race,
color, creed, sex, national origin, age or handicap, in the assignment, acceptance,
and activities of students in the program established by this Agreement.
3. The number of students shall be agreed upon by the University and the Facility.
The Board of Trustees of
The University of Alabama for
The University of Alabama at Birmingham
By: ___________________________ By: _________________________
Department Authorization Board of Trustees Authorization