1 School logo here MENTAL HEALTH SOCIAL WORK STIPEND STUDENT CONTRACT ACADEMIC YEAR THIS AGREEMENT between (hereinafter University ) and Master of Social Work Student (hereinafter Student or Graduate ) currently residing at is entered into this day of, 20. By entering into this Agreement, the Student attests to the following: A. His or her intent to participate in the Mental Health Program (hereinafter Program ) offered under the auspices of the California Social Work Education Center (CalSWEC). B. His or her acceptance in and pursuit of the Advanced year of a graduate course of study in social work/social welfare at the University beginning, 20 and ending not later than, 20, leading to a Master of Social Work/Social Welfare degree. Obligations of the University and of the Student/Graduate under this Agreement are as follows: Article I. OBLIGATIONS OF THE UNIVERSITY The University will: A. Provide Student with an $18,500 annual stipend for one year of participation in the Program contingent upon good academic standing and upon availability of stipend funds. B. Assign Student to an appropriate field placement in a county public mental health agency, or a community-based organization under contract to a county public mental health agency. 1 C. Inform Student that if submission to and satisfactory completion of criminal background prescreening pursuant to Department of Justice or other applicable regulation permitted 1 The Public Mental Health System includes publicly funded mental health programs/services and contractor services that are administered, in whole or in part, by County Mental Health Agencies. (Office of Statewide Health Planning and Development definition)
by law is a requirement for field placement and/or employment in a county public mental health agency, or a community-based organization under contract to a county public mental health agency, Student must comply with this requirement within the first semester or quarter of program enrollment. D. Assist Student in the employment search process to obtain a position in a county public mental health agency, or a community-based organization under contract to a county public mental health agency, consistent with a Graduate s obligations set forth in II(B)(1) below, by providing information about job openings and application processes in local counties and statewide. E. Suspend or terminate stipend payments if Student is not performing satisfactorily in the Program. If University determines that Student is not performing satisfactorily in courses and field work, or is not making satisfactory academic progress, or has violated established University codes of student conduct, or is out of compliance with the Program requirements, University reserves the right to suspend stipend payments or to discontinue Student s participation in the program. Prior to such action, University will give Student notice of its intent to suspend or terminate payments. Article II. OBLIGATIONS OF STUDENT/GRADUATE A. PRESCREENING AND PROGRAM PROVISIONS 1. Student agrees to complete and maintain satisfactory academic progress and performance in courses, training, seminars, field placements and other surveys or instruments designated by the University to satisfy the requirements within one academic year. 2. If Student has not completed the degree within the specified time frame, and if it is determined by the University that a good faith effort to complete the academic requirements has been made, Student may request a modification of the time frame by which completion of the academic requirements must be achieved. If Student does not complete academic requirements by June 30, 2015, Student may be required, at the election of the University, to return all or a portion of the stipend funds paid to the Student pursuant to this Agreement. 3. Student has a duty to disclose any previous or subsequent conviction of any crime. Such conviction may disqualify Student from field placement or employment in a county public mental health agency, or a community-based organization under contract to a county public mental health agency, and may therefore render Student ineligible for, or cause Student s termination from the Program. 4. If required by a field placement or employer, Student agrees, within the first semester or 2
quarter of Program enrollment (placement), or in accordance with agency requirements (employers), to be pre-screened, to be fingerprinted and to participate in the criminal clearance process pursuant to Department of Justice or other applicable screening regulations governing mental health employment in California. 5. Unless specifically waived by the University in writing, Student agrees to maintain a valid driver s license and any insurance required by the field placement or payback employer. 6. Student will maintain the status of a citizen or permanent resident of the United States throughout program participation including the employment obligation. 7. Student is committed to seek and obtain employment for one calendar year for each academic year for which the stipend is granted, within the specified time frame, in a county public mental health agency, or a community-based organization under contract to a county public mental health agency. 3 B. EMPLOYMENT OBLIGATIONS 1. Graduate agrees to make a good faith effort 2 to seek, apply for, accept, and provide evidence of employment within 180 days of graduation 3 in a county public mental health agency, or a community-based organization under contract to a county public mental health agency in a position at least at a level appropriate to a new MSW in mental health within the state of California. Graduate must accept one of the first three qualifying positions offered, as described above. Except as set forth below, the position must be a full-time position, as defined by the employing organization. 2. Graduate must render one calendar year of continuous and satisfactory employment in a position at a level appropriate to a new MSW in mental health services. 3. The payback obligation described in II (B)(1) above may be satisfied through full-time, part-time, or unpaid employment (volunteering). If an employment or volunteer position is part-time, time must be pro-rated accordingly, e.g. Graduate with a half-time position must render two calendar years of employment to complete the equivalent of one calendar year of full-time employment. 4. Graduate may use volunteering to meet the payback obligation under any of the 2 Good Faith Effort as used in this document will include making applications to all county public mental health agencies, or a community-based organizations under contract to a county public mental health agency within the state of California, keeping satisfactory documentation of the employment search and keeping the University informed of employment search activities and any barriers to the employment search that arise. 3 Graduation is the date of degree conferral.
4 following conditions: Graduate has searched for paid employment in an eligible agency for at least 180 days following graduation; Graduate s individual situation warrants, as determined by the University, seeking volunteer positions upon graduation in lieu of a period of job-searching for full-time employment. Examples include: Graduates with a mental illness that impairs jobseeking activities and traditional employment; Graduates who are caring for a family member with a mental illness; Graduates with an acute or chronic health condition that affects progress toward full-time employment in a county or contract agency within stated timelines. The field placement agency offers a volunteer position to Graduate upon graduation. Graduate is offered volunteer hours while seeking employment. 5. If Graduate has not secured paid employment or a University-approved volunteer position within 180 days of graduation in a county public mental health agency, or a community-based organization under contract to a county public mental health agency, Graduate may be required, at the election of the University, to return all or a portion of the stipend funds paid to the Student pursuant to this Agreement. However, if Graduate has demonstrated that a good faith effort to secure paid or unpaid employment has been made, then Graduate may request in writing to the University a modification of the time frame by which qualifying employment must be obtained. Modifications of the agreement will be for a specific time frame. The University may deny the request in its sole discretion, or the University may forward the request with its endorsement to CalSWEC. This request will be not be approved by the University unless it is first approved by CalSWEC and the Office of Statewide Health Planning and Development (OSHPD). 6. If a modification of the time frame is approved by CalSWEC and OSHPD, and then also by the University, Graduate must engage in an on-going comprehensive employment search of all qualifying agencies within all counties of the State of California during the modified time frame, and keep satisfactory documentation 4 in the form of a job search log and copies of correspondence. 4 Satisfactory documentation must include names of all agencies contacted during the search period, dates of contact, positions applied for, and names and telephone numbers of persons contacted during the entire employment search period. This information is to be entered on a job search log. Copies of written and/or electronic correspondence are necessary as supporting documentation.
5 C. MONETARY REPAYMENT OBLIGATIONS 1. If Student begins but does not finish the academic school year for any reason, fails to register, withdraws from the University or from participation in the educational stipend program, is terminated from the program, or fails to graduate within the specified period of time or approved time modification(s), Student agrees to repay to the University all stipend funds received. 2. If Graduate withdraws from the program after graduation, or does not make a good faith effort to obtain qualifying employment, or declines qualifying employment, or fails to respond to requests by the University to provide evidence of qualifying employment, or fails to qualify 5 for appropriate employment, or is discharged from county employment under applicable County Civil Service rules or policies or is terminated prior to completion of the employment requirement due to unsatisfactory work performance 6 Graduate agrees to repay to the University all stipend funds received and costs incurred by University or its fiscal agent in securing repayment. 3. Repayment may be in the form of a lump sum payment, or Student may request that a repayment plan be established with the University or its fiscal agent in the University s sole discretion at an agreed-upon amount each month, for a period of time not to exceed five years, the sum of all amounts received as support, together with all attorney s fees and other costs and charges necessary for collection, including interest on the unpaid balance at the rate of percent ( %) per annum beginning no later than the fourth calendar month following the date of termination of enrollment. Rates of interest shall be determined by the interest schedule of rates of the University attended. 4. If Graduate begins monetary repayment, and subsequently takes eligible payback employment, employment may be substituted for monetary repayment on a pro-rated basis with the approval of the University. 5. Should repayment not be received in a timely manner, University or its fiscal agent may undertake, but is not limited to, the following measures: 1) block Graduate s records and withhold transcripts pursuant to University regulations, 2) Intercept Graduate s tax returns and apply funds toward any amounts owed, and 3) Report delinquent repayment status to available credit bureaus. 5 Failure to qualify includes failing the interview, medical or psychological examination and/or criminal clearances. 6 Unsatisfactory work performance includes but is not limited to: inadequate professional performance; conviction of a felony or misdemeanor crime that would disqualify an individual from service in a county public mental health agency, or a community-based organization under contract to a county public mental health agency; improper conduct as described by County Code/Merit System or Classified Personnel System, or violation of the National Association of Social Workers (NASW) Code of Ethics.
6. Collection costs and interest on the unpaid balance are determined by the University programs then in effect. D. INTERRUPTION OF EMPLOYMENT OBLIGATION DUE TO STUDENT HARDSHIP, DISABILITY OR DEATH 1. If Graduate interrupts fulfillment of the employment obligation due to hardship or temporary disability, the Graduate shall notify the University and may request modification of the employment obligation for a specific time frame, or may withdraw from the program and repay stipend funds received on a pro-rata basis of qualifying employment completed. 2. The Graduate may seek a waiver of repayment obligations in the case of permanent disability or serious behavioral or medical health hardship, including death, which prevents eligible employment within 550 days (18 months) of degree conferral. A waiver of the employment repayment obligation requires written application to the University by the Graduate or Graduate s legal representative. The University will not approve any such application absent the approval of CalSWEC. E. EVALUATION CONTACT INFORMATION The current expectation is that the Graduate will be contacted initially for program compliance and evaluation purposes no later than 180 days following graduation and at other times until completion of the employment or payback obligation. The Graduate may also be contacted after completion of payback obligation for the purpose of tracking retention in the mental health field. Consequently, Students and Graduates are required to cooperate and participate in the following ways: 1. Student/Graduate provides the University and CalSWEC with permanent and updated contact information. 2. Student/Graduate gives consent to be contacted by the University and/or by CalSWEC for the purpose of confirming completion of employment requirements and for conducting reasonable evaluation efforts, and agrees to participate in such efforts. 6 Article III. CONTRACT MONITORING AND LIMITED PRIVACY WAIVER A. The University and CalSWEC are required to monitor the post-graduation of Graduates to ensure program compliance and to determine, verify, and report to OSHPD the completion of each stipend employment commitment. The University and CalSWEC will collect and analyze data to meet contractual reporting requirements and to evaluate the effectiveness of the Mental Health Program. Information shared by the University with CalSWEC and by CalSWEC with OSHPD
7 will be submitted electronically. B. Information collected and potentially reported includes, but is not limited to: 1. Name of student participating in the program 2. Student s county of residence 3. Student s current contact information 4. Student[s field placement agency 5. Student s date of graduation (degree conferral) 6. Graduate s payback employment agency 7. Self-reported student racial, gender and ethnic identification. 8. Self-reported language proficiency other than English. C. On an annual basis, CalSWEC will provide to OSHPD the following information, provided to CalSWEC by the University, for monitoring purposes about the current cohort of stipend students: 1. Name of each student in the cohort 2. Student s county of residence 3. Student s field placement agency and type of agency (county-operated or contract nonprofit) 4. Student s expected date of graduation 5. Self-reported student gender (aggregated) 6. Self-reported racial/ethnic background (aggregated) 7. Self-reported language proficiency other than English (aggregated). 8. Other information as agreed upon by CalSWEC and OSHPD. D. Progress reports will be made quarterly by CalSWEC to OSHPD. Information received from the University is aggregated by school, and includes, but is not limited to: 1. Current Enrollment Names and number of stipend students Changes in number of students Changes in field placements Expected and actual graduation date (month/year) 2. Payback Employment (Previous cohort only) Graduates employed Graduates seeking employment Graduates who entered cash payback Graduates who completed payback Graduates who have another payback status (e.g. still completing academic requirements)
8 3. Payback Completion Graduates from other cohorts who have completed payback Method(s) of payback (employment, cash, volunteering) 4. Requests for extensions Number of extension requests reviewed and approved or denied by CalSWEC and OSHPD. 5. Core competencies implementation Progress toward developing and implementing curricula that address core competencies for recovery-oriented practice in public mental health systems. Article IV. ADDITIONAL CONTRACTUAL TERMS A. Waiver. Any failure of University at any time, or from time to time, to enforce or require the strict keeping and performance by Student of any of the terms or conditions of the Agreement shall not constitute a waiver by the University of such a breach of any such terms or conditions and shall not affect or impair such terms or conditions in any way, or the right of the University at any time to avail itself of such remedies as it may have or any such breach or breaches of such terms or conditions. B. Severability. In the event any portion of this Agreement is declared void by a court of competent jurisdiction, such portion shall be severed from this Agreement, and the remaining provisions shall remain in effect, unless the effect of such severance would be to substantially alter the Agreement or obligations of the parties, in which case the Agreement may be immediately terminated. 3. Precedence. In the event there is a conflict between any of the foregoing and the following Article V, the foregoing (Articles I- III) shall control. 4. Disputes. In cases involving Student/Graduate appeals to CalSWEC of University decisions regarding program administration, decisions of CalSWEC and OSHPD shall be final.
9 Article V. REVIEW AND ACKNOWLEDGEMENT Student will review these statements and indicate by initials that he or she has read the foregoing Contract and agrees to be bound by its provisions, including, but not limited to, the following: Initials Prescreening and Program Provisions Student will maintain satisfactory academic progress and will satisfactorily complete the courses, training, seminars, field placements, and other surveys or instruments designated by the University to satisfy the requirements of the Program within the specified time frame. If required by a field placement agency, Student agrees, within the first semester or quarter of Program enrollment, to be fingerprinted and to participate in the criminal clearance process as required by the Department of Justice and other applicable regulations. Student will maintain status as a citizen or as a permanent resident of the U.S. during participation in the program, including the employment obligation. Student will maintain the use of a valid driver s license and auto liability insurance as necessary for field placement and payback at all times during Program participation. Employment Repayment Obligations Graduate will fulfill the Program obligation after graduation through completion of one (1) calendar year of qualifying employment for the academic year of support received. After graduation, Graduate will seek, apply for, accept, and provide evidence of qualifying employment in a county public mental health agency, or a community-based organization under contract to a county public mental health agency within the state of California as described in the contract. Upon request by the University, Graduate will provide written documentation of the entire employment search as outlined in this contract If required by employer, Graduate agrees to be fingerprinted and to participate in the criminal clearance process as required by the Department of Justice and other applicable regulations. After Graduate has completed one calendar year of qualifying employment, Graduate will provide evidence of completion of employment to the University.
If, after 180 days of graduation, Graduate has not secured qualifying employment within the state of California, Graduate is subject to payback. However, if a good faith effort has been made to obtain qualifying employment and Graduate has not yet secured qualifying employment, Graduate may request in writing to the University a modification of the time frame by which qualifying employment must be obtained. Modifications must be specific, and evidence of good faith efforts to secure employment must be presented. The University may deny the request, or it may forward the request with its endorsement to CalSWEC. If a modification of time is approved by CalSWEC and OSHPD, an on-going comprehensive search for qualifying employment within all counties and jurisdictions of the state of California must be made within the modified time frame. This decision is final. Monetary Repayment Obligations (If Employment Obligation is not completed) If Student/Graduate enters into a payback agreement and fails, without written approval of the University, to make any scheduled monthly payment according to the repayment agreement, the total amount still owed shall, at the option of the University, become immediately due and payable. By entering into this Agreement with the University, Student/Graduate hereby authorizes the University or its fiscal agent to recover the total accrued amount still owed plus interest, applicable costs, late fees, and attorney s fees by any means provided by law. Student Information The University and CalSWEC may conduct compliance and program evaluation activities. In order participate and assist in these activities, Student/Graduate agrees to provide the University and CalSWEC with permanent contact information, and to provide reasonable response to requests for information. Student/Graduate will inform the University of any change in name, mailing or e-mail address, or phone number until such time as employment obligation has been fulfilled or any amount owed under this agreement is paid in full or otherwise retired. Student/Graduate agrees to be contacted by the University and/or by CalSWEC for the purpose of confirming completion of employment requirements and for conducting reasonable program evaluation efforts, and agrees to participate in such efforts. Student/Graduate agrees to respond to requests from the University to verify completion of employment obligation, program compliance or general inquiries within two weeks of the request. 10
Information that is collected by the University may be shared with CalSWEC and OSHPD for the purposes of contract compliance and program evaluation activities. If Student/Graduate requests a modification of this agreement to complete academic or payback employment requirements, the Student/Graduate agrees that the University may share relevant information about the reasons for the request with CalSWEC and CalSWEC may share the information with OSHPD in order to make an informed decision on the request. 11
12 RELEASE OF INFORMATION I give the University permission to submit information maintained by the University about me to CalSWEC including: 1. My name 2. My county of residence 3. My field placement agency and type of agency (county-operated or contract nonprofit) 4. My date of graduation 5. My progress toward payback employment 6. My payback employment agency or cash payback status 7. My self-reported racial, gender and ethnic identification 8. My self-reported language(s) spoken. 9. Other information as necessary to carry out the terms of my stipend agreement. I understand that reporting to CalSWEC and OSHPD are necessary for the purpose of monitoring the effectiveness and outcomes of the program, and that the University would therefore not be able to provide stipends such as the stipend provided to Student pursuant to this Agreement without such monitoring. I therefore agree that University may disclose the personal information described above in this release to CalSWEC and/or OSHPD. I agree to this disclosure of personal information even if, but for this authorization to disclose, the information would be protected from disclosure by laws regulating personal and medical privacy. The University, CalSWEC and OSHPD will follow all legal and ethical requirements to protect said information, and will not disclose such private information to other parties unless the information is provided in aggregated form and stripped of any personally identifying information. If I request a modification of this agreement in order to complete academic or payback requirements, I give the University permission to share relevant information about my circumstances with CalSWEC and give permission to CalSWEC to share the information with OSHPD. If the information that I share includes information regarding my health or behavioral health status or that of my family members, then I consent to the release of such information to CalSWEC and eventually to OSHPD, even if that information would otherwise be protected by laws or regulations governing privacy, including without limitation medical privacy or educational privacy. I understand that, as above, The University, CalSWEC and OSHPD will follow all legal and ethical requirements to protect said information. Further, I understand that the reason that I am waiving my privacy rights is that, but for my waiver, CalSWEC and OSHPD would not have sufficient information to determine whether or not my individual circumstances warrant a modification of my agreement. Student Name Student Signature Date
13 AFFIRMATION I hereby attest that I have never been convicted of a felony or misdemeanor crime that would disqualify me from service in a county public mental health agency, or a community-based organization under contract to a county public mental health agency. I hereby attest that I have never been discharged from a county public mental health agency or a community-based organization under contract to a county public mental health agency county or other social services agency due to violation of county code/merit system rules or violation of agency or professional codes of ethics. In accepting a stipend from the Mental Health Program, I hereby agree to adhere to the provisions of this Agreement. Student must sign this agreement before receiving any stipend funds. Student Name Student Signature Date University Official - Name Position Signature Date