CCR2021051-AttachmentAGREEMENT BETWEEN
THE BOARD OF REGENTS OF THE UNIVERSITY OF WISCONSIN SYSTEM
ON BEHALF OF THE UNIVERSITY OF WISCONSIN-LA CROSSE AND
FOR THE CONDUCT OF
A CLINICAL EDUCATION PROGRAM IN A CLINICAL SETTING
This agreement is between the Board of Regents of the University of Wisconsin System on behalf of the University of
Wisconsin - La Crosse (hereinafter referred to as "University") and
(hereinafter referred to as "Facility"). In consideration of the mutual benefits to the respective parties, any and all departments
of the University wishing to enter into a clinical education program with the Facility, and the Facility agree to the terms set forth
below.
THE UNIVERSITY AGREES:
1.That each school or college of the University wishing to participate in a clinical education placement program with the
Facility will annually provide the Facility with a Program Memorandum, detailing the academic content of the proposed
program. Upon acceptance of this Program Memorandum as provided hereafter, it shall become a part of this agreement and
shall be incorporated by reference. The Program Memorandum will include discussion of program concepts; the controls which
the University and the Facility may exercise or are required to exercise; the rights of the Facility to send representatives to
review the University's program; the number of students to be assigned, the qualifications of those students and the schedules
of those students; and/or any other matters pertaining to the specific program proposed by the department.
2.To provide the Facility with a listing of students who will be participating under the program and to update that listing
periodically.
3.For purposes of this Agreement, the parties acknowledge that University is considered a unit within the agency of the State
of Wisconsin by virtue of being part of the University of Wisconsin System. University therefore provides liability (i.e., general
liability) and professional liability coverage for its employees, faculty, students, and agents consistent with §§895.46(1) and
893.82(6) of the Wisconsin Statutes. Employees, faculty, students, and agents who participate in the activities resulting from
this Agreement are agents and employees, respectively, of the State of Wisconsin, and while participating in such activities
are acting within the scope of their agency or employment. The liability and professional liability coverage provided by the
State of Wisconsin under §§895.46(1) and 893.82(6) is self-funded and provides funding for claims, demands, losses, and
damages of every kind and description (including death), or damage to persons or property arising out of activities performed
under this Agreement and founded upon or growing out of the negligent acts or omissions of any of the employees, faculty,
students, or agents of University while acting within the scope of their employment or agency where protection is afforded by
§§895.46(1) and 893.82(6) of the Wisconsin Statutes.
THE FACILITY AGREES:
1.To review any Program Memorandum concerning a clinical education program which is submitted by a school or college of
the University. Upon review, the Facility will notify the school or college of its acceptance or rejection of the academic program
proposal.
2.To satisfy the provisions contained in 45 CFR 46, existing for the protection of human subjects, to the extent that such
regulations are applicable to the respective program involved. The University will provide a copy of such regulations upon
request and will make its institutional review board available to the Facility for consultative purposes.
3.Not to accept students as participants in the program unless the student is certified as a program participant in writing by the
appropriate clinical work coordinator of a particular University school or college.
THE UNIVERSITY AND THE FACILITY JOINTLY AGREE:
1.That there shall be no discrimination against students on the basis of the students' race, color, creed, religion, sex, national
origin, disability, ancestry, age, sexual orientation, pregnancy, marital status or parental status.
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3.Intentionally Deleted.
4.By executing this agreement, neither the University nor the Facility waives any constitutional, statutory or common law
defenses, nor shall the provisions of agreement create any rights in any third party.
5.The parties agree that the University, its employees, and its students are not "business associates" of the Facility as
defined in 45 CFR, 160.103, for the limited purposes of HIPAA.
TERM OF AGREEMENT:
This Agreement shall be for a term of commencing on unless terminated as provided by
this Agreement. This Agreement may be terminated at the will of either party by giving thirty (30) days written notice to the
other, provided however, both parties hereto shall exert their best efforts to provide a mechanism whereby students who are
currently in this educational program be allowed to complete the educational program without interruption. Program
Memoranda presented by the University and accepted by the Facility shall be for a term of no longer than one year. They
may be renewed upon mutual agreement. Such Program Memoranda do not require the further approval of either party
provided they contain provisions relating solely to program arrangements and content. All such Program Memoranda must
be approved by the respective school or college within the University. Such Memoranda shall be effective for a period of one
year. All fully executed Program Memoranda shall be incorporated by reference and become a part of this agreement if not
inconsistent in any manner with this agreement. The parties acknowledge that this Agreement specifically covers students
in University's Recreation Management program.
COVID-19 SITE ACKNOWLEDGEMENT:
The University appreciates Facility’s willingness to provide an on-site learning experience for our students. The University
has the utmost concern for the safety of all students and business partners. As an institution of higher education, the
University always wants to help our students achieve their educational objectives. Challenging situations have been
created by the global pandemic related to COVID-19 and we want to partner with you to ensure reasonable steps are taken
to provide a safe environment for our students. Facility agrees to observe, to the best of its ability, the COVID-19 guidelines
from the Centers for Disease Control (CDC) as well as applicable federal, state, and local restrictions. In addition, the
Facility will either provide personal protective equipment (PPE) or provide advisement to the student(s) on obtaining
adequate PPE.
UNIVERSITY AND FACILITY CONTACTS:
The following shall be University and Facility contacts on matters pertaining to this agreement.
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FOR THE BOARD OF REGENTS OF THE UNIVERSITY OF
WISCONSIN SYSTEM on behalf of the UNIVERSITY OF
WISCONSIN-LA CROSSE:
UNIVERSITY
Name: __________________________________________________
Title: ____________________________________________________
Telephone: _______________________________________________
E-Mail: ___________________________________________________
________________________________________________________
Dean's Office Approval Date
FACILITY
Name: __________________________________________________
Title: ____________________________________________________
Telephone: _______________________________________________
E-Mail: ___________________________________________________
FOR THE FACILITY:
_________________________________________________________
Signature of Authorized Official Date
_________________________________________________________
Name Typed or Printed
_________________________________________________________
Title
___________________________________________________________
Robert J. Hetzel Date
Vice Chancellor for Administration and Finance
___________________________________________________________
Nathan Schlavensky Date
Contract Administrator
or
2.That the State of Wisconsin will indemnify University employees, officers, and agents (students in required training, a credit
program, or for graduation) against liability for damages arising out of their activity while acting within the scope of their
respective employment or agency, pursuant to § 895.46(1) and 893.82, Wis. Stats.