United States Department of Veterans Affairs
Office of Academic Affiliations

Affiliation Agreements

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Educational Affiliation Agreements

Adobe Acrobat document VHA Affiliations Partnership Councils
VHA Handbook 1400.3 Outlines procedural requirements for establishing, administering and maintaining Affiliation Partnership Councils and associated subcommittees or sub-councils (e.g., Medical Education Sub-council).

Adobe Acrobat document VHA Directive 2004-066
Defines policy for educational affiliation agreements covering training programs in clinical settings.

Medical Education Agreements

Between the V.A. and a School of Medicine and its Affiliated Participating Institutions.
For programs accredited by the Liaison Committee for Medical Education (LCME) or the Accreditation Council for Graduate Medical Education (ACGME).

Microsoft Word document  VA Form 10-0094A    Revised November, 2010


Adobe Acrobat document Between the V.A. and a School of Osteopathic Medicine and its Affiliated Participating Institutions.
For programs accredited by the American Osteopathic Association Bureau of Professional Education or the Executive Committee of Council on Postdoctoral Training (ECCOPT).

Microsoft Word document VA Form 10-0094B 


Adobe Acrobat document Between the V.A. and Institutions Sponsoring Graduate Medical Education.
For ACGME-accredited programs not affiliated with a school of medicine.

Microsoft Word document VA Form 10-0094C

Dental Education Agreements

Adobe Acrobat document Between the V.A. and a School of Dentistry as the Sponsoring Institution.
For programs accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of the dental school.

Microsoft Word document VA Form 10-0094D


Adobe Acrobat document Between the V.A. as the Sponsoring Institution, and a School of Dentistry and its Affiliated Institutions.
For programs accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of VA.

Microsoft Word document VA Form 10-0094E


Adobe Acrobat document Between the V.A. and Institutions Sponsoring Dental Education
For programs accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of the sponsoring institution.

Microsoft Word document VA Form 10-0094F

Associated Health Education Agreements

Adobe Acrobat document Between the V.A. and an Educational Program.
For programs approved by an accrediting body recognized by the U.S. Department of Education or by the Council for Higher Education Accreditation (CHEA).

Microsoft Word document VA Form 10-0094G


Adobe Acrobat document Between the V.A. and a non-VA Healthcare Facility or Agency.
For VA-sponsored programs where trainees receive training in a non-VA health care facility or agency.

Microsoft Word document VA Form 10-0094H


Microsoft Word document Psychology Internship Education Affiliation Agreement Between VA and a School of Psychology

Psychology Affiliation Agreement Instructions

Background

Until four years ago, each facility had to develop its own Affiliation Agreements with each school for each intern coming into the program. With 350 graduate programs (clinical and counseling) and constantly differing origins of the new classes, this developed into quite a chore each year - both for VA facilities and for the schools. Working with the Office of General Counsel, OAA has developed a template for a National Affiliation Agreement for Psychology Internships. This allows the schools to affiliate with VA on a national basis rather than separately with each VA site. Since there is no expiration date for these agreements (unless the school insists on one), most remain in effect indefinitely.

Procedure

OAA asks each VA program to check for the presence of a valid Affiliation Agreement and to initiate the process for completing one if needed. Based on the match results provided to OAA by 90% of VA internship sites, please see the programs that require an agreement at this time. Universities with an * noted have trainees matched at multiple VA facilities, but only one national agreement is necessary.

  • Ball State University - Clinical
  • East Carolina University - Clinical *
  • Eastern Tennessee State University - Clinical
  • Indiana State University - Clinical *
  • Long Island University, Brooklyn Campus - Clinical *
  • Loyola University, Chicago - Clinical
  • Midwestern University, Glendale - Clinical *
  • Notre Dame - Clinical
  • Radford University - Counseling
  • Tulane University - School
  • University of Alaska, Anchorage - Clinical
  • University of Buffalo - Counseling
  • University of Florida - Counseling *
  • University of Illinois, Urbana/Champaign - Clinical (expires June 30, 2013)
  • University of Kentucky - Counseling *
  • University of North Dakota - Counseling
  • University of North Texas - Counseling *
  • University of Oklahoma - Counseling
  • University of Windsor, Ontario - Clinical

  1. We recommend starting this process now. Though there is no requirement that this be complete until just before the interns begin, be aware that many universities have very challenging bureaucracies; it may take months for an affiliation agreement to be reviewed by their legal departments and get the appropriate signatures.
  2. Please go to the OAA website (http://vaww.oaa.med.va.gov/DBAHealth/ahPsyAffiliationList1.aspx) to verify that, for each incoming intern, there is already a valid Affiliation Agreement in place.
  3. If you find an Affiliation Agreement posted, please open it and review for accuracy and completion. OAA has tried to track all data entries, but we need your eagle eyes to be sure everything is absolutely correct. In particular, please check to be sure no one has entered an expiration date that we failed to note.
  4. If there is not already an Affiliation Agreement for an incoming intern's home graduate program or if the existing one has expired, please begin the process of developing a new one. VA facilities differ in terms of who assumes responsibility for this - it could be either the Psychology Training Program or the Education Office - so please be sure that the Training Program Office and Education Office are very clear about who will be responsible. Once determined, you should use the template found on our OAA website (http://www.va.gov/oaa/ahe_policy.asp). The blank template can be found near the bottom of the page under "Associated Health Education Agreements" or can be accessed with this link: (Psychology Internship Affiliation Agreement). For your convenience a copy of the template is also attached to this correspondence.
  5. The blank template should be completed very precisely with the name of the school (including city and state) and the Program Name and Type of Degree offered. Since some universities have graduate degrees in Psychology from multiple divisions, precision in this is required. If we are unable to tell which part of a university is included, we will have to return the agreement to you for revision.
  6. After you collect signatures from the university, please send the original Affiliation Agreement to Dr. Robert Zeiss (Address Below) for signature and posting on the OAA web site
  7. Be aware that mailings are regularly delayed for up to a week for security screening; if there is urgency, please use an expedited delivery service.
  8. If you want a paper or electronic copy sent to the university, please include the name and address of any individuals the copy should go to.
  9. OAA is generally able to post agreements fairly quickly, but it could take a week or longer if Dr. Zeiss is out of the office, so please be aware of the timing.

Robert A. Zeiss, Ph.D.
Office of Academic Affiliations (10A2D)
Department of Veterans Affairs
810 Vermont Ave NW
Washington, DC 20420.