Office of Academic Affiliations
- Medical (UME/GME) Affiliation Agreements
- Dental Affiliation Agreements
- Associated Health Education Affiliation Agreements
- Department of Defense (Military) Affiliation Agreements
Medical Affiliation Agreements
Undergraduate Medical Education (UME) Affiliation Agreements. Medical Education Affiliation Agreement between Department of Veterans Affairs (VA) and Institutions with Undergraduate Medical Education. VA Form 10-9054
Graduate Medical Education (GME) Affiliation Agreements. Medical Education Affiliation Agreement between Department of Veterans Affairs (VA) and Institutions with Graduate Medical Education. VA Form 10-9055
AFFILIATION AGREEMENT QUICK GUIDE
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
PLEASE 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
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)
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)
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-USUHS Affiliation Agreement, USUHS Trainees going to VA Facility VA-AFIT Affiliation Agreement, U.S. Air Force Institute of Technology(AFIT) Trainees going to VA Facility For all DoD (Active Duty, Reserve, Guard) medical personnel who want to maintain clinical currency and war readiness at a VAMC , please contact Rochelle Clark at Rochelle Clark@va.gov, (202) 461-4143 or Craig Turner at Craig Turner@va.gov, (202) 461-4044. Thank you.