This page provides definitions and links to affiliation agreement forms and UW System policy.
Criminal Background Check (CBC)
Related Information and Links
Many academic departments require students to have clinical or field experiences (internships) as a part of the curriculum necessary to graduate, and such training experience is usually attained with an off-site facility (affiliate) in cooperation with the particular academic department.
When the internship is a graduation requirement, there should be an Affiliation Agreement between UW-La Crosse and the facility, and it should contain a Program Memorandum. If the internship is voluntary or not required for graduation, then an Affiliation Agreement is not required.
Students who are required to complete off-site experiences in order to earn their degrees are considered agents of the State of Wisconsin for liability purposes while in the conduct of the experiences. The State of Wisconsin provides limited liability protection for its agents, and students are encouraged to have personal liability insurance before beginning the experiences. Many facilities require this insurance. The State of Wisconsin does not insure students for injuries incurred by the student at the facility. These injuries are generally covered by the student's health insurance.
If the affiliate provides its own Affiliation Agreement, it should be provided to Business Services for review and approval after the department is satisfied with the program content.
All Affiliation Agreements and separate Program Memoranda may be signed by one of the UW-La Crosse officers specifically delegated such authority by the Chancellor (see
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Affiliates will usually have students complete a national Criminal Background Check prior to admission into their program. Academic departments should use an outside contractor for these checks, and the costs should be borne by the students. Currently, the Department of Health Professions uses the services of
. Academic departments may require the CBC at the time of admission or at a time deemed appropriate by the affiliate. It is up to each affiliate to determine how to assess CBC results, and each should have a process in place that provides for fair process. CBC results need to be kept in a secure location. Contact Risk Management at 608.785.8569 if you need assistance with CBC's.
This document contains the primary terms to which UW-La Crosse and the affiliate agree. At a minimum it provides for the following:
Period of the agreement.
Requirement for a Program Memorandum.
Points of contact.
Applicable statutes and governing law.
Templates for clinical Affiliation Agreements are at
Contracts and Agreements.
The Program Memorandum is the document developed by the academic department that details the specific requirements of the academic program. It is a statement of agreement between the affiliate's coordinator and the academic department involved, and it can be used to evaluate the quality of the off-site experience. The Program Memorandum should not contain any reference to liability, indemnification, or insurance protection, as these items are contained in the Affiliation Agreement. The Program Memorandum may be an attachment to the Affiliation Agreement, or it may be a separate agreement. An example format is the
Coordinate and schedule the off-site experience with the facility.
Provide a UW-L template for the Affiliation Agreement or receive an agreement from the facility for content review.
Develop the Program Memorandum in coordination with the facility.
Return signed agreements to the facilities and maintain records of them.
Review Affiliation Agreements and Program Memoranda for completeness and consistency with state law and UW policy.
Negotiate any problems with the affiliate facility.
Obtain approvals and signatures.
Affiliation Agreements for Clinical Education Programs
Program Memorandum Example Format
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