Va Form 10-0094c - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (Va) And Institutions Sponsoring Graduate Medical Education
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6MEDICAL EDUCATION AFFILIATION AGREEMENT BETWEEN
DEPARTMENT OF VETERANS AFFAIRS (VA)
AND INSTITUTIONS SPONSORING GRADUATE MEDICAL EDUCATION
Use when trainees are enrolled in an ACGME-accredited program not affiliated with a school of medicine
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VA NETWORK
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VA MEDICAL CARE FACILITY (including city and state)
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AFFILIATED PARTICIPATING INSTITUTION #1 (including ACGME ID number, city, and state)
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AFFILIATED PARTICIPATING INSTITUTION #2 (including ACGME ID number, city, and state)
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AFFILIATED PARTICIPATING INSTITUTION #3 (including ACGME ID number, city, and state)
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AFFILIATED PARTICIPATING INSTITUTION #4 (including ACGME ID number, city, and state)
This agreement, when duly executed and approved by the Department of Veterans Affairs (VA), establishes
an affiliation between VA, its Veterans Integrated Service Networks, the listed VA facility or facilities, and the
listed institutions sponsoring graduate medical education for the academic purposes of enhanced patient care,
education, and research. VA and the affiliated participating institutions have a shared responsibility for the
academic enterprise. Additional responsibilities are delineated below.
TERMS OF AGREEMENT
Ultimate responsibility for the control and operation of VA facilities and programs rests with VA. Ultimate
responsibility for academic education rests with the participating institutions. Through this agreement, a
partnership is created to enable enhanced patient care, education, and research.
The participating institutions comply with Title VI of the Civil Rights Act of 1964, section 504 of the
Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, Public Law 104-91, and the Age
Discrimination Act of 1975, and all related regulations, and assures that they do not, and will not, discriminate
against any person on the basis of race, color, sex, disability, or age under any program or activity receiving
federal financial assistance.
VA FORM 10-0094c
PAGE 1 OF 6
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