Nurse Aide Affiliation Agreement Requirements

(BPSS-39, updated 05/2018)

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. Process for verification for attendance at the affiliation site.
  6. Assurance that 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. Provision for insuring the student against injuries resulting from the internship.
  10. Provision that students and instructors will be covered by liability insurance against liability for injuries/damage towards third parties (such as patients) 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. Provision for school visitation and/or oversight of the internship site.
  15. Provision for ensuring proper student conduct at the internship site.
  16. Provision for Specific conditions and procedures for terminating a student.
  17. Provision for either party to terminate the affiliation agreement.
  18. A newly signed agreement must be sent with the curriculum reapproval.

Sample Nurse Aide Affiliation Agreement