Va Form 10-0094h - Education Affiliation Agreement Between The Department Of Veterans Affairs (Va) And A Non-Va Health Care Facility Or Agency

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EDUCATION AFFILIATION AGREEMENT BETWEEN
THE DEPARTMENT OF VETERANS AFFAIRS (VA)
AND A NON-VA HEALTH CARE FACILITY OR AGENCY
Use when trainees in a VA-sponsored program receive training in a non-VA health care facility or agency
4
VA NETWORK
4
VA MEDICAL CARE FACILITY (including city and state)
4
VA SPONSORED PROGRAM/DISCIPLINE AND DEGREE(S)
4
NAME OF NON-VA HEALTHCARE FACILITY OR AGENCY (including 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
non-VA healthcare facility or agency for the academic purposes of enhanced patient care, education, and research.
VA and the affiliated non-VA health care facility or agency have a shared responsibility for the academic
enterprise. It is mutually agreed that clinical or practical experience for trainees in the specified VA sponsored
educational program be provided at the non-VA health care facility or agency. Through this agreement, a
partnership is created to enable enhanced patient care, education, and research. 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 in the VA sponsored program rests with VA. Ultimate responsibility for the
control and operation of non-VA health care facilities or programs rests with the non-VA health care facility or
agency.
The non-VA health care facility or agency and VA 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 10-0094h
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