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Affiliation Agreements

Handbooks | VHA Forms & Publications | VA Forms | VA Publications

VHA Affiliations Partnership Councils

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).

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Medical Affiliation Agreements

VHA Notice 2018-37, Rescission of VHA Directive 2010-046, Use of Acknowledgement Agreements When Disclosure of Protected Health Information (PHI) is Made to Affiliated Educational Institutions, has been signed by the Under Secretary and has been published.

VHA NOTICE 2018-37

Note: Effective August 15, 2018 the following Affiliation Agreement Templates will replace the previously existing versions.


MEDICAL EDUCATION AFFILIATION AGREEMENT BETWEEN DEPARTMENT OF VETERANS AFFAIRS (VA) AND INSTITUTIONS WITH UNDERGRADUATE MEDICAL EDUCATION (UME)

Undergraduate programs of Allopathic and Osteopathic Colleges/Schools of Medicine. VA Form 10-9054

UME National Affiliation Agreement


GRADUATE MEDICAL EDUCATION AFFILIATION AGREEMENT BETWEEN DEPARTMENT OF VETERANS AFFAIRS (VA) AND INSTITUTIONS SPONSORING GRADUATE MEDICAL EDUCATION (GME)

Graduate programs of Allopathic and Osteopathic Colleges/Schools of Medicine. VA Form 10-9055

GME National Affiliation Agreement


AFFILIATION AGREEMENT QUICK GUIDE

Guide outlining any questions you may have regarding your affiliation agreement.

Affiliation Agreement Quick Guide


Note: Effective October 1, 2017, the VHA Office of Academic Affiliation (OAA) requires that all new and updated affiliation agreements routed to VA Central Office (VACO) should be sent via PDF and carry electronic signatures.

OAA Memo to Field: Conversion of Agreements to PDF

For assistance with affiliation agreements, please contact Yolanda Seward by phone at (804) 381-8374 or by email at Yolanda.Seward@va.gov

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Dental Affiliation Agreements

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.

VA Form 10-0094D (fillable)


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.

VA Form 10-0094E (fillable)


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.

VA Form 10-0094F (fillable)

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Associated Health Education Agreements

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).

VA Form 10-0094G (fillable)


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

VA Form 10-0094H (fillable)


Between the V.A. and another VA Healthcare Facility
For VA-sponsored programs where trainees receive training in another VA healthcare facility.

VA Form 10-0094I (fillable)


Psychology Internship Education Affiliation Agreements

Psychology Internship Education Affiliation Agreement Instructions

VA Form 10-00094j (fillable)
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DoD Agreements


Use of VA Facility to Maintain Clinical or Administrative Skills

VA-DoD Affiliation Agreement - VA Trainees going to Armed Service Medical Treatment Facility

VA-DoD Affiliation Agreement - Armed Service Trainee going to VA

VA-DoD Reserve Unit Sharing Agreement

VA-DoD Guard Unit Sharing Agreement

For all VA & DoD Healthcare Resources Sharing Agreements (including all maintenance of clinical skills and competencies under VA supervision) and for all DoD (Army, Air Force & Navy) Active Duty, Reserve, State Army National and Air Guard personnel who wish to train/practice in VHA facilities please contact Rochelle Clark at Rochelle.Clark@va.gov, or (202) 461-4143.