AGREEMENT OF AFFILIATION between Metropolitan State University of Denver (hereinafter referred to as the University or MSU Denver ) And <Community Partner> (hereinafter referred to as the Partner ) PURPOSE This document constitutes an agreement between the parties for the purpose of providing a supervised learning experience for students. This experience is intended to supplement the student s educational curriculum as well as to assist in developing future resources for all parties. MUTUAL AGREEMENTS 1. Agreement Period This Agreement shall become effective on, 20, or the date it is signed by both parties, whichever is later (the Effective Date ), and shall automatically renew each year upon the anniversary of the Effective Date unless terminated pursuant to number 4 of this Mutual Agreements section of this Agreement. 2. Periodic conversations and/or meetings between the University and the Partner, in consultation with students, will be held to assure continuous evaluation of this program. 3. The internship shall provide learning experiences that give the student the opportunity to: a) Observe the role of a qualified supervisor in the Partner setting. b) Gain an understanding of community and professional resources. c) Acquire knowledge and skill in working with clients, their families, and community members when appropriate. 4. Termination for Convenience Except as otherwise provided herein, either Party may terminate this Agreement at any time without cause upon at least thirty (30) days prior written notice, provided that all students working with the Partner at the time of notice of termination shall be given the opportunity to complete the Program under these terms and conditions, such completion not to exceed the current academic term or five (5) months. Any notice required by this Agreement shall be given to the Administrator of the Partner Agency or the of the University by the notifying party. Said notice shall be in writing, postage prepaid, and shall be personally delivered or sent by certified mail, return receipt requested. The notice shall be effective on the date personally delivered or the date of receipt indicated on the return receipt, as the case may be. 5. EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER. MSU Denver and the Facility shall not unlawfully discriminate because of race, color, religion, gender, age, national origin, marital status, disability or status as a Vietnam veteran, Page 1 of 6
as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment-related activities concerning the Facility and MSU Denver. In addition, the Facility and the MSU Denver affirms that they are equal opportunity and affirmative action employers, and shall comply with all applicable federal, state, and local laws and regulations including, but not limited to, executive order 11246 as amended by 11375 and 12086; 12138; 11625; 11758; 12073; the Rehabilitation Act of 1973, as amended; the Vietnam Era Veterans Readjustment Assistance Act of 1975; Civil Rights Act of 1964; Equal Pay Act of 1963; Age Discrimination in Employment Act of 1976; Immigration Reform and Control Act of 1986; Public Law 95-507; the Americans With Disabilities Act; and any additions or amendments thereto. The Equal Opportunity Clauses set forth in 41 CFR 60-1.4 and 41 CFR 60-741.5 are hereby incorporated by reference into this Agreement. UNIVERSITY RIGHTS/RESPONSIBILITIES The University will: 1. Prepare the student for the internship through classroom instruction and laboratory practice. 2. Provide liaison with the Partner by means of oral and written communication, and arrange a site visit (in person or otherwise) to the Partner during each placement. 3. Assume overall responsibility for the general educational experience assigned to the Partner including: determination of educational goals for each student; establishing prerequisite criteria for the placement; determination of completion of assignments; guidelines for final evaluation of student s performance; and approval of staff members who will participate in the education of University students. 4. The University will not perform background checks on program applicants and makes no representations or warranties as to the fitness of applicants for program participation. 5. Insurance and Indemnity for all unpaid placements. a) At all times during the term of this agreement, MSU Denver will maintain in force and effect policies requiring each and every registered student and employee to be covered by a policy of health insurance. In addition, MSU Denver will make demonstrated compliance with this health insurance requirement a prerequisite for each Student and Employee s participation in the Program. b) At all times during the term of this agreement, MSU Denver will comply with the Colorado Workers Compensation Act with respect to students and faculty participating in the program. c) At all times during the term of this agreement, MSU Denver shall provide Students and Faculty Members who participate in the program with indemnity against liability for their covered acts and omissions through the Colorado Risk Management Division, pursuant to section 24-30-1501 CRS, et seq. and in accordance with the provisions of the Colorado Governmental Immunity Act, section 24-10-101 CRS, et seq. Any material adverse changes in those laws after execution of this agreement shall be cause for immediate termination of the program. Page 2 of 6
d) No term of this agreement shall be construed as either: (1) a waiver of sovereign immunity by the University or the state of Colorado; or (2) an acceptance of the Colorado governmental immunity act as constitutional or a waiver of claims against the state based upon any theory of liability. e) MSU Denver warrants and represents that it is an entity covered by the State of Colorado s self-insurance program pursuant to Part 101 to 120, Article 10 of Title 24, Colorado Revised Statutes, the Facility and MSU Denver understand that liability for claims for injuries to persons or property arising out of acts or omissions of MSU Denver and certain covered individuals is controlled and limited by the Colorado Constitution, the Colorado Governmental Immunity Act, (C.R.S. 24-10-101 et seq.), and the Risk Management Act ( 24-30-1501 et seq.). PARTNER RIGHTS/RESPONSIBILITIES The Partner will: 1. Orient the student to Partner policies and procedures. 2. Maintain a work environment free from harassment in all forms as described in the established Human Resources policy of the Partner s organization. 3. Provide emergency medical care if necessary in the event of a student s accident or illness while the student is on the premises, but will not be financially responsible for the charges involved, follow-up care or hospitalization. Notwithstanding the foregoing, nothing herein shall waive or release Partner s liability to student for gross negligence or willful misconduct. 4. Provide ongoing, qualified supervision to the student. 5. Provide appropriate learning experiences and work with the student to meet learning objectives as outlined in his/her learning contract. 6. Complete a written evaluation of the student s performance at the close of the internship. 7. Immediately notify the University of any emergency or of any problem(s) which may threaten the student s ability to successfully complete the internship. 8. When deemed necessary, perform all necessary background checks of students. 9. WITHDRAWAL OF PROGRAM PARTICIPANTS. a) The Partner may immediately remove from the premises any student who poses an immediate threat or danger to personnel or to the quality of health services or for unprofessional behavior. b) The Partner may request MSU Denver to withdraw or dismiss a student or other Program Participant from the Program at the Facility when his or her performance is unsatisfactory to the Partner or his or her behavior, in the Partner s discretion, is disruptive or detrimental to the Partner and/or its clients. In such event, said Program Participant's participation in Page 3 of 6
the Program at the Partner location shall immediately cease. Subject to the provisions of paragraph 9(a) above, it is understood that only MSU Denver can dismiss the Program Participant from the Program. 10. Standard Insurance Requirements A. The Partner shall obtain, and maintain at all times during the term of this Agreement, insurance in the following kinds and amounts: 1. Workers Compensation Insurance as required by state statute, and Employer s Liability Insurance covering all of Facility s employees acting within the course and scope of their employment. 2. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Facilities, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: a. $1,000,000 each occurrence; b. $1,000,000 general aggregate; c. $1,000,000 products and completed operations aggregate; and d. $50,000 any one fire. If any aggregate limit is reduced below $1,000,000 because of claims made or paid, the Facility shall immediately obtain additional insurance to restore the full aggregate limit and furnish to the State a certificate or other document satisfactory to the State showing compliance with this provision. STUDENT RIGHTS/RESPONSIBILITIES The student will: 1. Adhere to professional standards established by the discipline and the Partner in the provision of services. 2. The student shall adhere to the MSU Denver policies (including but not limited to Department policies) and student code of conduct as well as the policies, procedures and regulations of the Partner. 3. A copy of this agreement shall be made available to the student. 4. The student shall be responsible for securing personal transportation to and from the site. 5. Students will not transport clients. 6. Students will maintain open lines of communication with the Partner and University supervisors. 7. Students shall be given a 15-minute break for each 4 hours worked and a lunch break of at least 30 minutes for each 5.5 hours worked. Page 4 of 6
GENERAL PROVISIONS 1. This Agreement may be changed only by written amendments signed by both parties hereto. Any attempt to amend this Agreement without mutual written consent shall be void. 2. Both parties understand that placements are usually one semester in length, the student selects the site, and placements are at the discretion of the University. This Agreement shall be effective when executed by both parties for a period of one (1) year and shall be automatically renewed annually unless otherwise terminated by written notice by one of the parties in accordance with the paragraph three (3) below. 3. There will not be a financial commitment between the Partner and the student, and nothing in this Agreement shall be construed to create a relationship of employer and employee between the Partner and the student. 4. Nothing in this Agreement is intended to or shall create any rights or remedies in any third parties. 5. Notice All notices required to be given by the parties hereunder shall be hand delivered or sent by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing substitute addresses or persons to whom such notices shall be sent. For the University: Metropolitan State University of Denver Professional Studies, Campus Box 8 PO Box 173362 Denver, CO 80217-3362 Ph: Fx: For the Facility: 6. School of Professional Studies (SPS) adopted specific placement guidelines: A. Grounds for removal or mediation 1. A student, field supervisor / rotation supervisor / site supervisor / proctor / classroom teacher, faculty, MSU Denver representative or placement coordinator may provide for the removal of student experiential learners. In this matter, each agent maintains the right to request, at any time, after consulting with the University supervisor, cooperating supervisor (supervisor), and MSU Denver departmental director of internships & field experiences, the removal of any student experiential learner for due cause (please see also any departmental or placement site policies and/or guidelines). 2. The process for removal or mediation shall follow departmental policies, however, if there are not existing policies, the following guidelines should be followed: (i) A removal or remediation action must begin with notification of appropriate parties involved in the placement. (ii) After notification, parties may schedule a mediation to try and remedy the situation (the mediation may be conducted via phone or in-person) except in circumstances Page 5 of 6
where there are immediate or eminent safety concerns. A plan of action to correct the situation will be established. (iii) If the plan of action is unsuccessful, the placement will be terminated and the individual parties will complete an exit interview. (iv) Documentation of the grounds, process, and outcome is required. Each department will designate a representative to maintain records and documentation. (v) For appeal process refer to MSU Denver Student Handbook and/or departmental appeal processes. B. Out of State and Abroad 1. A student may opt to complete a placement out of the state of Colorado under the following conditions: (i) The program will allow such a placement (ii) Students must receive program/departmental approval for this type of placement (iii) Departments or Programs may have additional requirements for abroad or out-ofstate placements (iv) At the department discretion, student may meet with the Applied Learning Center to complete release of liability paperwork and to organize details related to temporary relocation A. The student secures a supervisor who meets departmental guidelines and who is willing to meet all standard placement agreements. B. The student will arrange appropriate communication necessary to meet the requirements of the course. ADDENDUM Subject to the written authorization by appropriate representatives of the University and the Partner, addenda to this agreement may be developed to facilitate day to day and year to year execution of the goals of the agreement. Each addendum shall be in writing and executed by an authorized representative of each of the parties. To the extent an addendum is not properly executed by persons authorized to do so and to the extent it conflicts or contradicts the terms herein, it shall be considered null and void. ACCEPTANCE The parties hereto execute this agreement: For Partner For MSU Denver Signature Signature Title Title Date Date Page 6 of 6