Nurse Aide Affiliation Agreement Requirements

(BPSS-21, updated)

An affiliation agreement must be submitted and approved for each nurse aide curriculum. The following information/conditions must be identified in the agreement:

  1. Specific name and location of the proprietary school.
  2. Specific name and location of the Residential Healthcare Facility (RHCF) AND a photocopy of its operating certificate.
  3. Exact dates/or length, of the affiliation experience.
  4. Number of students to be supervised during one affiliation period.
  5. Who is responsible for taking attendance at the affiliation site.
  6. Students will not displace or replace regular employees.
  7. The school agrees to maintain sufficient affiliation sites to accommodate all qualified students.
  8. The school is responsible for insuring that the student has had a physical exam within 6 months before starting the internship, and all recommended inoculations.
  9. School or Externship site (usually the school) is responsible for insuring the student against injuries resulting from the internship. [If the school insurance does not cover the internship site, then the school either buys insurance for interns and rolls that insurance into the tuition, or makes available to interns the purchase of such insurance coverage. In the latter case, in addition to the name of the company, and the extent of coverage, the cost to students must be noted in the Externship Agreement]
  10. Students and instructors will be covered by liability insurance against liability towards third parties arising from the internship. The insurance carrier, cost and exact insurance coverage must be identified.
  11. The school is responsible for providing all theory/practice instruction.
  12. The school will use the Dept. of Health SKILLS checklist at the internship site.
  13. Students will be supervised at ALL times during affiliation.
  14. How often the nurse aide program coordinator will visit the affiliation.
  15. The school is responsible for the conduct of the students at the affiliation site.
  16. Specific conditions and procedures for terminating a student.
  17. How much notice must be given by either party to terminate the agreement.
  18. A newly signed agreement must be sent with the curriculum reapproval.

Sample Nurse Aide Affiliation Agreement