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Office of Academic Affiliations

Educational Affiliation Agreements

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Educational Affiliation Agreements

VHA Affiliations Partnership Councils This Veterans Health Administration (VHA) Handbook outlines the procedural requirements pertaining to establishing, administering and maintaining Affiliation Partnership Councils and associated subcommittees or sub-councils (e.g., Medical Education Sub-council).

VHA Directive 2004-066 defines policy for educational affiliation agreements covering training programs in clinical settings. The directive contains eight (revised November 18, 2004) affiliation agreement templates designed to accommodate the range of clinical disciplines and various sponsorship arrangements for educational programs. Links to those templates appear below.

Other resources in Microsoft Word format:   Word Doc Plug-in
Microsoft Word document Letter to VISN Director
Microsoft Word document Fact Sheet
Microsoft Word document Letter to Deans of Schools of Medicine
Microsoft Word document Sample letter for Schools of Medicine
Microsoft Word document Sample Letter: Associated Health

The agreement documents below are made available in both Adobe Acrobat and Microsoft Word formats.
The first link to each agreement is in Adobe Acrobat file.
The second link is the identical agreement in Microsoft Word format.
Adobe Acrobat document Medical Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and a School of Medicine and its Affiliated Participating Institutions. VA Form 10-0094A is to be used when trainees are enrolled in an academic program accredited by the Liaison Committee for Medical Education (LCME) or the Accreditation Council for Graduate Medical Education (ACGME).  
Microsoft Word document  Microsoft Word format VA Form 10-0094A.
Adobe Acrobat document Medical Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and a School of Osteopathic Medicine and its Affiliated Participating Institutions.    VA Form 10-0094B is to be used when trainees are enrolled in an academic program accredited by the American Osteopathic Association Bureau of Professional Education or the Executive Committee of Council on Postdoctoral Training (ECCOPT).
Microsoft Word document Microsoft Word format VA Form 10-0094B. 

Adobe Acrobat document Medical Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and Institutions Sponsoring Graduate Medical Education.    VA Form 10-0094C is to be used when trainees are enrolled in an ACGME-accredited program not affiliated with a school of medicine.
Microsoft Word document Microsoft Word format  VA Form 10-0094C.

Adobe Acrobat document Dental Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and a School of Dentistry as the Sponsoring Institution.   VA Form 10-0094D is to be used when dental trainees are enrolled in an academic program accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of the dental school.
Microsoft Word document Microsoft Word format VA Form 10-0094D.
Adobe Acrobat document Dental Education Affiliation Agreement Between the Department of Veterans Affairs (VA) as the Sponsoring Institution, and a School of Dentistry and its Affiliated Institutions.   VA Form 10-0094E is to be used when dental trainees are enrolled in an academic program accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of VA. 
Microsoft Word document  Microsoft Word format  VA Form 10-0094E.
Adobe Acrobat document Dental Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and Institutions Sponsoring Dental Education    VA Form 10-0094F is to be used when dental trainees are enrolled in an academic program accredited by the Commission on Dental Accreditation ( CDA ) and the accreditation is in the name of the sponsoring institution.
Microsoft Word document Microsoft Word format  VA Form 10-0094F.
Adobe Acrobat document Associated Health Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and an Educational Program.   VA Form 10-0094G is to be used when trainees are enrolled in an educational program 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 Microsoft Word format VA Form 10-0094G.
Adobe Acrobat document Education Affiliation Agreement Between the Department of Veterans Affairs (VA) and a non-VA Healthcare Facility or Agency.   VA Form 10-0094H is to be used when trainees in a VA-sponsored program receive training in a non-VA health care facility or agency.
Microsoft Word document Microsoft Word format VA Form 10-0094H.
Other Agreements
VA & Department of Defense Reserve Unit
 


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