HomeMy WebLinkAboutVIII-05 Authorize Signature - Clinical Affiliation Agreement with Chippewa Valley Technical CollegeCity of Hastings 101 Fourth Street East Hastings, MN 55033-1944 Phone: 651-480-2350 www.hastingsmn.gov
City Council Memorandum
To: Mayor Fasbender & City Council Members
From:John Townsend, Fire Chief
Date:June 2,2025
Item:Clinical Affiliation Agreement with Chippewa Valley Technical College
Council Action Requested:
Approve agreement with Chippewa Valley Technical College (CVTC)for clinical education.
Background Information:
The Hastings Fire Department is a clinical site for students enrolled in EMS and Fire programs. These clinical
rotations include ride-a-longs for students working in EMS and Fire. We currently have a similar agreement
with Century College and will now include CVTC. Participation in this promotes education for our staff and
recruitment opportunities in the future.
Financial Impact:
None
Advisory Commission Discussion:N/A
Council Committee Discussion:None
Attachments:Agreement
CLINICAL AFFILIATION AGREEMENT FOR
HEALTH OCCUPATIONS
This Agreement is made effective this _21st _day of __May__, 2025 (“Effective Date”) by and
between the CHIPPEWA VALLEY TECHNICAL COLLEGE, INC. a Wisconsin institution for technical
education and training ("CVTC"), and Hastings Fire Department,a Minnesota clinical education setting
("Clinical Education Setting").
WITNESSETH
WHEREAS, CHIPPEWA VALLEY TECHNICAL COLLEGE administers educational curricula for
various health occupations (each a "Program" and collectively the "Programs"), and seeks to provide,
as part of the Program curricula, supervised clinical experiences for CHIPPEWA VALLEY TECHNICAL
COLLEGE students enrolled in the Programs ("Students"); and
WHEREAS, the Clinical Education Setting serves patients in various health services through the
provision of medical or other services consistent with the one or more Programs, and seeks to train
future health care practitioners by providing Students with supervised clinical experiences at the Clinical
Education Setting sites, consistent with the educational objectives of Students and CHIPPEWA
VALLEY TECHNICAL COLLEGE; and
WHEREAS, CHIPPEWA VALLEY TECHNICAL COLLEGE and the Clinical Education Setting
have determined that each may best accomplish its objectives by mutual assistance, and seek to
describe their affiliation in this Agreement combined with one or more Program Addenda attached (or
that later may be attached) to and made a part of this Agreement;
NOW THEREFORE, in consideration for the mutual promises contained herein, CHIPPEWA
VALLEY TECHNICAL COLLEGE and the Clinical Education Setting agree as follows:
AGREEMENT
1.CHIPPEWA VALLEY TECHNICAL COLLEGE RIGHTS AND RESPONSIBILITIES. In
addition to its rights and responsibilities described elsewhere in this Agreement,CHIPPEWA VALLEY
TECHNICAL COLLEGE shall have the following rights and responsibilities:
1.1 Preparation of Students for Clinical Placement. CHIPPEWA VALLEY
TECHNICAL COLLEGE shall ensure, through qualified faculty, that each Student assigned to the
Clinical Education Setting is adequately prepared to benefit from such assignment. A Student's
preparedness shall be measured by: (i) academic performance indicating an ability to understand what
Student will observe and/or perform during the clinical placement; and (ii) appreciation of the nature
and seriousness of the work Student will observe and/or perform.
1.2 Assigning Students to the Clinical Education Setting. After receiving from the
Clinical Education Setting the number of placements available for Students, CHIPPEWA VALLEY
TECHNICAL COLLEGE shall select Students to be assigned to the Clinical Education Setting.
CHIPPEWA VALLEY TECHNICAL COLLEGE shall notify the Clinical Education Setting of the Students
assigned to the Clinical Education Setting, and each Student’s availability for participation in clinical
experiences.
1.3 Educational Coordinator. CHIPPEWA VALLEY TECHNICAL COLLEGE shall
appoint a faculty member to serve as Educational Coordinator for each Program, and shall
communicate his or her name, title and telephone number to the Clinical Education Setting. The
Educational Coordinator shall be responsible for overall management of the Students' educational
experience, and may be assigned as Educational Coordinator for one or more Programs.
Clinical Affiliation Agreement for Health Occupations 2
1.4 Professional Liability Insurance. CHIPPEWA VALLEY TECHNICAL COLLEGE
shall provide to each Student assigned to the Clinical Education Setting professional liability insurance
pursuant to Section 8.1 of this Agreement. This coverage shall be provided at no cost to the Clinical
Education Setting.
1.5 Accreditation and Licensure. CHIPPEWA VALLEY TECHNICAL COLLEGE shall
maintain, at all times during the term of this Agreement: (i) accreditation as an educational institution;
(ii) all licensures and approvals from the State of Wisconsin necessary to the applicable Program; and
(iii) full and unrestricted accreditation of the Programs from the accrediting organization specified in the
applicable Program Addendum. CHIPPEWA VALLEY TECHNICAL COLLEGE shall promptly notify the
Clinical Education Setting of any change in its accreditation or licensure status.
1.6 Background Investigative Disclosure. If required, responsibility for background
investigative disclosure, pursuant to the Wisconsin Caregiver Background Check Law, shall be as
described in the Program Addendum.
2.CLINICAL EDUCATION SETTING RIGHTS AND RESPONSIBILITIES. In addition to its
rights and responsibilities described elsewhere in this Agreement, the Clinical Education Setting shall
have the following rights and responsibilities:
2.1 Number of Placements. The Clinical Education Setting shall have sole discretion
to determine its capacity to accept Students for clinical placement under this Agreement, whether such
capacity is described in terms of the number of Students on-site at any one time, the number of hours
of clinical supervision that the Clinical Education Setting can provide over a period of time, or other
such description of capacity. The Clinical Education Setting shall communicate such capacity to
CHIPPEWA VALLEY TECHNICAL COLLEGE before Students may be assigned to the Clinical
Education Setting.
2.2 Site Coordinator. The Clinical Education Setting shall appoint an employee to
serve as a coordinator at the site for each Program (for purposes of this Agreement, the "Site
Coordinator" and as may be described in the Program Addendum), and shall communicate his or her
name, title and telephone number to CHIPPEWA VALLEY TECHNICAL COLLEGE.The Site
Coordinator shall be responsible for overall management of the experience at the Clinical Education
Setting, and may be assigned as Site Coordinator for one or more Programs.
2.3 Orientation. The Clinical Education Setting shall provide CHIPPEWA VALLEY
TECHNICAL COLLEGE faculty and Students with a comprehensive orientation to the Clinical
Education Setting, including all applicable policies and procedures and expectations of the Clinical
Education Setting, and a tour of the physical plant. Such orientation shall include a comprehensive
orientation to the Clinical Education Setting's emergency and safety protocols and policies and other
orientation activities as may be mutually agreed to by X CHIPPEWA VALLEY TECHNICAL COLLEGE
and Clinical Education Setting as set forth in any Program Addendum attached hereto.
2.4 Qualified Supervision. Clinical Education Setting shall assure that a qualified
practitioner supervises each Student. A practitioner shall be qualified if he or she: (i) maintains
licensure or certification as appropriate for the particular Program; (ii) possesses adequate experience;
(iii) demonstrates competence in the area of practice; and (iv) demonstrates interest and ability in
teaching. The student to practitioner ratio shall not exceed that ratio specified in the applicable
Program Addendum, if any.
2.5 Student Access to the Clinical Education Setting and Patients. The Clinical
Education Setting shall permit access by Students to any and all areas of the Clinical Education Setting
as reasonably required to support Students' clinical development and as permitted under applicable
Clinical Affiliation Agreement for Health Occupations 3
law. These areas shall include, without limitation, patient care units, laboratories, ancillary departments,
health science libraries, cafeteria and parking facilities.
2.6 Accreditation. Licensure and Eligibility. The Clinical Education Setting shall
maintain, at all times during the term of this Agreement all qualifications necessary to provide services
under this Agreement, including: (i) full and unrestricted accreditation, as appropriate and as described
in the Program Addendum; (ii) all necessary licensures, certifications and approvals from the State of
Wisconsin or other authority; and (iii) if applicable, eligibility for participation in the Medicare and
Medicaid programs. The Clinical Education Setting shall immediately notify CHIPPEWA VALLEY
TECHNICAL COLLEGE of any change in the Clinical Education Setting’s qualifications, accreditation,
licensure or eligibility status.
2.7 Clinical Component Requirements. The clinical component offered by
CHIPPEWA VALLEY TECHNICAL COLLEGE shall in all respects be implemented and administered by
the Clinical Education Setting in a manner that meets the requirements of any agency that accredits,
licenses, certifies or otherwise oversees the Program, other authorities identified by CHIPPEWA
VALLEY TECHNICAL COLLEGE, and all applicable laws.
2.8 Inspections. The Clinical Education Setting shall, upon reasonable request,
permit inspection of its premises by CHIPPEWA VALLEY TECHNICAL COLLEGE.
2.9 Final Authority. The Clinical Education Setting retains final authority for all
aspects of operations at and management of the Clinical Education Setting.
2.10 Remuneration. Students may not receive remuneration for services relating to
the Program and performed for or on behalf of the Clinical Education Setting.
3.JOINT RIGHTS AND RESPONSIBILITIES. In addition to their rights and responsibilities
described elsewhere in this Agreement, CHIPPEWA VALLEY TECHNICAL COLLEGE and the Clinical
Education Setting shall have the following rights and responsibilities.
3.1 Supervision and Evaluation of Students. CHIPPEWA VALLEY TECHNICAL
COLLEGE and the Clinical Education Setting shall, in good faith, work cooperatively to assure
adequate supervision and evaluation of Students while Students are on-site at the Clinical Education
Setting. Both parties shall reinforce with Students: (i) the seriousness of the service being performed at
the Clinical Education Setting, including the Students’impact upon patients' wellbeing; (ii) the
importance of abiding by the Clinical Education Setting rules and regulations; and (iii) the confidentiality
of patient identities and health information. CHIPPEWA VALLEY TECHNICAL COLLEGE shall, if the
Clinical Education Setting so desires, assure prompt feedback to the Clinical Education Setting
regarding Students' evaluation of their clinical experience at the Clinical Education Setting. The Clinical
Education Setting shall assure prompt feedback to CHIPPEWA VALLEY TECHNICAL COLLEGE
regarding Students' performance at the Clinical Education Setting and additional feedback as described
in the Program Addendum, if any.
3.2 Review and Evaluation of Affiliation. CHIPPEWA VALLEY TECHNICAL
COLLEGE and the Clinical Education Setting agree to review and evaluate any and all aspects of their
affiliation at periodic intervals, and to work cooperatively to establish and maintain clinical experiences
that meet their respective objectives. This Agreement may be amended or modified, pursuant to
Section 6 below, to reflect changes in the parties' relationship.
3.3 Nondiscrimination. CHIPPEWA VALLEY TECHNICAL COLLEGE and the
Experience Setting shall comply with the Title VI of the Civil Rights Act of 1964, Title IX of the
Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Americans with
Clinical Affiliation Agreement for Health Occupations 4
Disabilities Act and all laws protecting the rights of the disabled. Both parties will not discriminate
against any faculty member, student, employee or applicant for employment or admission into a
Program, on the basis of race, color, age, gender, national origin, disability or marital status.
4.STUDENT RIGHTS AND RESPONSIBILITIES. CHIPPEWA VALLEY TECHNICAL
COLLEGE and the Clinical Education Setting shall instruct Students regarding Students' rights and
responsibilities while onsite at the Clinical Education Setting. These rights and responsibilities shall
include the following:
4.1 Conduct. Student shall, at all times while on the Clinical Education Setting
premises, conduct himself or herself in a professional manner and shall refrain from loud, boisterous,
offensive or otherwise inappropriate conduct. Student shall refrain from the improper use of alcohol or
other drugs, and shall not carry any firearms or other weapons while on the Clinical Education Setting
premises.Student shall abide by all policies, rules and regulations established by the Clinical
Education Setting and CHIPPEWA VALLEY TECHNICAL COLLEGE.Failure to abide by these
policies, rules and regulations may result in the student’s removal from the Clinical Education Setting.
4.2 Timeliness. Student shall report to the Clinical Education Setting at the assigned
place and time. Student shall immediately inform the Clinical Education Setting and CHIPPEWA
VALLEY TECHNICAL COLLEGE of Student's inability to report to the Clinical Education Setting as
assigned.
4.3 Uniform and Identification. Student shall wear the uniform or other clothing as
directed by X CHIPPEWA VALLEY TECHNICAL COLLEGE. Student shall display proper identification
as directed by the Clinical Education Setting. Student's appearance shall be, at all times, neat and
clean.
4.4 Insurance. Student shall maintain comprehensive health and medical insurance
or student health insurance as required under Section 8.3 of this Agreement.
4.5 Personal Expenses. While at the Clinical Education Setting, Student shall be
responsible for Student's personal expenses such as meals, travel, medical care and incidentals.
4.6 Evaluation of Clinical Experience.Student shall, upon request of CHIPPEWA
VALLEY TECHNICAL COLLEGE,or the Clinical Education Setting, provide a candid written evaluation
of the clinical experience at the Clinical Education Setting including, without limitation, preparation for
the on-site experience, orientation to the Clinical Education Setting and experience and supervision at
the Clinical Education Setting.
5.STUDENT HEALTH POLICIES
5.1 Emergency Medical Services. If Student is injured or becomes ill while at the
Clinical Education Setting, the Clinical Education Setting shall provide emergent or urgent medical care,
as appropriate, consistent with the Clinical Education Setting's capability and policies. The Clinical
Education Setting shall promptly notify CHIPPEWA VALLEY TECHNICAL COLLEGE that Student has
been injured or has become ill. Student shall bear full financial responsibility for charges associated
with said treatment.
5.2 Immunizations. CHIPPEWA VALLEY TECHNICAL COLLEGE shall assure that
Student has received, before reporting to the Clinical Education Setting, appropriate immunizations and
vaccines, or, in the alternative, has completed the appropriate declination of immunization form, notice
of which is provided to the Clinical Education Setting.
Clinical Affiliation Agreement for Health Occupations 5
5.3 OSHA Policies. Clinical Education Setting shall instruct Students regarding
precautions and other procedures to protect Students, patients and the Clinical Education Setting
personnel from blood borne and other pathogens.
6.TERM AND TERMINATION
6.1 Initial and Renewal Term. Subject to Section 6.2 below, this Agreement shall be
effective as of the date set forth above ("Effective Date") and shall continue for an initial term of one
academic or Program year as set forth in the Program Addendum. Thereafter, this Agreement shall
automatically renew and continue in full force and effect for any and all periods during which any
Student in a Program is placed at and accepted by the Clinical Education Setting.Notwithstanding the
foregoing, either party may choose not to renew this Agreement at the end of the then-current Program
by providing the other with not less than one hundred twenty (120) days' advance written notice of its
intent not to renew prior to the end of then-current Program. In the event that either party's non-renewal
of this Agreement disrupts the clinical experience of any Student(s) in a Program, the Agreement shall
remain in full force and effect until such time as this Agreement may expire without disruption of said
Student(s)' clinical experience. Upon notice of non-renewal by either party, no new Student may be
placed at the Clinical Education Setting.
6.2 Termination. Notwithstanding Section 6.1 above, this Agreement may be
terminated as follows.
A.By Mutual Agreement. CHIPPEWA VALLEY TECHNICAL COLLEGE and
the Clinical Education Setting may terminate this Agreement at any time, and on any terms, to which
they agree in writing, though the parties shall attempt, in good faith and using their best effort, to
effectuate the termination to coincide with a normal academic or Program break.
B.For Cause. In the event CHIPPEWA VALLEY TECHNICAL COLLEGE or
the Clinical Education Setting fails in any substantial manner to perform as required herein, this
Agreement may be terminated as described below:
(1)Either party may terminate this Agreement at any time, upon
material breach of any of its provisions by the other party; provided, however, if such breach is curable,
that not less than thirty (30) days prior to termination, written notice shall be given by the non-breaching
party to the breaching party that states the intention of the non-breaching party to terminate this
Agreement, the nature of the material breach giving rise to termination, and shall permit the breaching
party reasonable opportunity to cure such material breach to the reasonable satisfaction of the
non-breaching party during said thirty (30) day period.
(2)If the material breach is not resolved to the reasonable satisfaction
of the non-breaching party during the thirty (30) day period as provided in B. (1) above, the non-
breaching party shall immediately give the breaching party written notice of termination of the
Agreement.
(3)In the event that termination of the Agreement by the Clinical
Education Setting pursuant to this Section 6.2 (B) disrupts the clinical experience of any Student(s) in a
Program, the parties shall attempt, in good faith and using their commercially reasonable best efforts, to
continue Students' clinical experiences and this Agreement shall remain in full force and effect until
such time as this Agreement may expire without disruption of said Students' clinical experience. During
any time period in which notice of termination has been given and existing Students are completing the
Program, no new Student may be placed at the Clinical Education Setting.
Clinical Affiliation Agreement for Health Occupations 6
C.Immediate Termination. CHIPPEWA VALLEY TECHNICAL COLLEGE
may immediately terminate this Agreement and any and all Program Addenda if the Clinical Education
Setting fails to maintain full and unrestricted accreditation, licensure and, if applicable, eligibility as
required under Section 2.6 of this Agreement. The Clinical Education Setting may terminate this
Agreement immediately upon written notice to CHIPPEWA VALLEY TECHNICAL COLLEGE if
CHIPPEWA VALLEY TECHNICAL COLLEGE fails to maintain full and unrestricted accreditation and
licensure as required under Section 1.5 of this Agreement. In addition, the Clinical Education Setting
may also terminate any Program Addenda if CHIPPEWA VALLEY TECHNICAL COLLEGE fails to
maintain full and unrestricted accreditation with respect to said Program as required under the
applicable Program Addendum.
6.3 Effect of Termination. Upon termination of this Agreement, no party shall have
any further obligation hereunder except for obligations accruing under the terms of this Agreement prior
to the date of termination.
6.4 Amendments and Modifications. This Agreement may be changed at any time
with the written approval of the parties. Such amendments or modifications will be written, signed by
the parties and made a part of this Agreement.
7.INDEMNIFICATION AND LIABILITY
7.1 CHIPPEWA VALLEY TECHNICAL COLLEGE. CHIPPEWA VALLEY
TECHNICAL COLLEGE shall indemnify, defend and hold harmless the Clinical Education Setting, its
governing board, officers, employees and agents from and against any and all liabilities, claims, losses,
lawsuits, judgments, and/or expenses including attorney fees, arising, either directly or indirectly, from
any act or failure to act by CHIPPEWA VALLEY TECHNICAL COLLEGE or any of its employees.
CHIPPEWA VALLEY TECHNICAL COLLEGE shall indemnify the Clinical Education Setting for any
negligent acts or omissions by any Student that may arise during the course and scope of the clinical
experience as described in this Agreement and the attached Program Addenda. CHIPPEWA VALLEY
TECHNICAL COLLEGE shall not indemnify the Clinical Education Setting for any willful acts or failures
to act by any Student that may arise out of this Agreement and attached Program Addenda.
7.2 The Clinical Education Setting. The Clinical Education Setting shall indemnify,
defend and hold harmless CHIPPEWA VALLEY TECHNICAL COLLEGE,its governing board, officers,
faculty, employees and agents from and against any and all liabilities, claims, losses, lawsuits,
judgments, and/or expenses including attorney fees, arising, either directly or indirectly, from any act or
failure to act by the Clinical Education Setting or any of its employees, agents, medical residents or
members of its medical staff that may occur during or that may arise out of this Agreement.
7.3 Costs. In the event each party is found to be at fault, then each shall bear its
own costs and attorney fees and its proportionate share of any judgment or settlement based on its
percentage of fault, as determined by a procedure established by the parties.
7.4 Survival. This Section 7 shall continue beyond the expiration, non-renewal or
termination of this Agreement.
8.INSURANCE.
8.1 CHIPPEWA VALLEY TECHNICAL COLLEGE. CHIPPEWA VALLEY
TECHNICAL COLLEGE shall maintain, at no cost to the Clinical Education Setting, general and
professional liability insurance covering CHIPPEWA VALLEY TECHNICAL COLLEGE as an entity and
each of its employees and agents against general and professional liability claims, in the minimum
Clinical Affiliation Agreement for Health Occupations 7
amount of one million dollars ($1,000,000) per occurrence. Evidence of such insurance shall be
provided to the Clinical Education Setting upon request.
8.2 The Clinical Education Setting. The Clinical Education Setting shall maintain, at
no cost to CHIPPEWA VALLEY TECHNICAL COLLEGE,general and professional liability insurance
covering the Clinical Education Setting as an entity and each of its physician-employees, nonphysician-
employees, medical residents and agents against professional liability claims, in the minimum amount
of one million dollars ($1,000,000) per occurrence.Clinical Education Setting agrees to list CHIPPEWA
VALLEY TECHNICAL COLLEGE as an additional insured on all policies required to be maintained
under this Section 8.2 and to promptly provide CHIPPEWA VALLEY TECHNICAL COLLEGE with
evidence of such insurance upon request.
8.3 Students. Students shall maintain, at no cost to CHIPPEWA VALLEY
TECHNICAL COLLEGE or the Clinical Education Setting (unless either such party consents to such
cost), comprehensive health and medical insurance or student health insurance.Evidence of such
insurance shall be provided to CHIPPEWA VALLEY TECHNICAL COLLEGE and Clinical Education
Setting upon request.
9.DISPUTE RESOLUTION. Any dispute arising under or in any way related to this
Agreement that is not resolved by agreement of CHIPPEWA VALLEY TECHNICAL COLLEGE and
Clinical Education Setting may be submitted by either party to binding arbitration pursuant to the
Commercial Arbitration Rules of the American Arbitration Association. The parties agree that such
arbitration shall result in a final and binding award in the State of Wisconsin, and may be judicially
enforced. Each party shall bear its own arbitration costs and expenses, unless otherwise determined
by the arbitrator.
10.NOTICES AND COMMUNICATION.
10.1 Notices. All notices under this Agreement shall be given in writing and shall be
deemed to have been properly given when delivered:
If to CHIPPEWA VALLEY TECHNICAL COLLEGE: If to the Clinical Education Setting:
Myra Reuter John Townsend
Exec Dean of Allied Health & Emergency Services Fire Chief
615 Clairemont Avenue 115 west 5th Street
Eau Claire, WI 54701 Hastings, MN 55033
or at other such addresses as a party from time to time may designate by written notice to the other
party.
10.2 Other Communications.Communications, other than notices as described in
Section 10.1 above, whether written or oral, shall be directed to the appropriate CHIPPEWA VALLEY
TECHNICAL COLLEGE Dean, Educational Coordinator or Site Coordinator as indicated in the
applicable Program Addendum.
11.NON-EXCLUSIVE. The parties agree that CHIPPEWA VALLEY TECHNICAL
COLLEGE shall be free to enter into similar agreements with other facilities, and that the Clinical
Education Setting shall be free to enter into similar agreements with other educational institutions.
Clinical Affiliation Agreement for Health Occupations 8
12.GOVERNING LAW. This Agreement shall be governed by and construed in accordance
with the Laws of the State of Wisconsin.
13.INVALID PROVISION. The invalidity or unenforceability of any particular provision of
this Agreement shall not affect the other provisions hereof, and this Agreement shall be construed in all
respects as if such invalid or unenforceable provision were omitted.
14.ASSIGNMENT. No assignment by a party of this Agreement or its rights and
responsibilities hereunder shall be valid without the specific written consent of the other party.
15.RELATIONSHIP OF PARTIES. CHIPPEWA VALLEY TECHNICAL COLLEGE and the
Clinical Education Setting, including their respective agents and employees, shall be, at all times,
independent contractors of the other. Nothing in this Agreement is intended or shall be construed to
create a joint venture relationship, a partnership, a lease, or a landlord/tenant relationship. Should any
governmental agency question or challenge the independent contractor status of CHIPPEWA VALLEY
TECHNICAL COLLEGE,the Clinical Education Setting or their employees, both CHIPPEWA VALLEY
TECHNICAL COLLEGE and the Clinical Education Setting, upon receipt by either of them of notice,
shall promptly notify the other party and afford the other party the opportunity to participate in any
government agency discussion or negotiations, irrespective of how such discussions are initiated.
Clinical Affiliation Agreement for Health Occupations 9
16.CONFIDENTIALITY OF RECORDS
16.1 Student Records. CHIPPEWA VALLEY TECHNICAL COLLEGE and the Clinical
Education Setting acknowledge that many student educational records are protected by the Family
Educational Rights and Privacy Act ("FERPA") and that, generally, student permission must be
obtained before releasing specific student data to anyone other than CHIPPEWA VALLEY TECHNICAL
COLLEGE. CHIPPEWA VALLEY TECHNICAL COLLEGE agrees to provide the Clinical Education
Setting with guidance with respect to compliance with FERPA.
16.2 Patient Health Care Records. CHIPPEWA VALLEY TECHNICAL COLLEGE and
the Clinical Education Setting acknowledge that patient health information is protected under Wisconsin
law (e.g., Wis. Stat. §§ 146.82, 51.30 and 252.15) and the Health Insurance Portability and
Accountability Act ("HIPAA") and its accompanying regulations. The Clinical Education Setting agrees
to provide Students and CHIPPEWA VALLEY TECHNICAL COLLEGE with guidance with respect to
compliance with these statutes and regulations.
17.NON-DISCRIMINATION. CHIPPEWA VALLEY TECHNICAL COLLEGE and the Clinical
Education Setting shall not unlawfully discriminate against any individual on the basis of race, creed,
color, sex, religion, age, disability or national origin, and shall comply with applicable anti-discriminatory
laws and policies promulgated by CHIPPEWA VALLEY TECHNICAL COLLEGE.
18.ENTIRE AGREEMENT. This Agreement, together with one or more Program Addenda
attached (or that later may be attached) hereto, constitutes the entire agreement between the parties
and contains all the agreements between the parties with respect to the subject hereof. This Agreement
supersedes any and all other agreements, in writing or oral, between the parties hereto with respect to
the subject matter thereof.
THIS AGREEMENT PRESUMES THE EXECUTION OF ONE OR MORE PROGRAM ADDENDA.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.
CHIPPEWA VALLEY TECHNICAL
COLLEGE:
By:
Its:Executive Dean of Allied Health &
Emergency Services
Date: May 21, 2025
CLINICAL EDUCATION SETTING:
By:
Its:
Date:
Disclaimer for Acknowledgement of Risks / Acceptance of Responsibility Agreement and
Release:
This document is a template Agreement and Release that sets forth the “best practices” in
protecting both the organization and its student participants. The document attached is not to be
construed as legal advice, such being specifically denied. This document is intended to be used
in conjunction with written program materials. The potential risks and benefits of participating in
a particular program should be outlined as specifically as possible. The written program
materials should be reviewed on a regular basis to ensure that they reflect the current demands
and requirements of the program. The written materials should clearly state that admission to
the Program cannot be deemed a guarantee of clinical or work experience placement.
Clinical Affiliation Agreement for Health Occupations 10
PROGRAM ADDENDUM TO THE CLINICAL AFFILIATION
AGREEMENT FOR HEALTH OCCUPATIONS
This Program Addendum is made effective this __21st__day of __May__, 2025 (“Effective
Date”) by and between CHIPPEWA VALLEY TECHNICAL TECHNICAL COLLEGE, INC.a Wisconsin
institution for technical education and training ("CVTC”) and Hastings Fire Department, a Minnesota
clinical education setting ("Clinical Education Setting").
WHEREAS, CHIPPEWA VALLEY TECHNICAL COLLEGE and Clinical Education Setting have
executed a Clinical Affiliation Agreement for Health Occupations dated _5/21/2025_ ("Agreement") that
describes their relationship regarding educational and clinical experiences for Students enrolled in one
or more of CHIPPEWA VALLEY TECHNICAL COLLEGE’S health occupation programs; and
WHEREAS, the Agreement presumes the execution of a Program Addendum pertaining to each
health occupations program to which it applies and any capitalized terms not defined in this Program
Addendum shall have the meaning set forth in the Agreement; and
WHEREAS, the parties desire to execute this Program Addendum to effectuate the Agreement
with regard to CHIPPEWA VALLEY TECHNICAL COLLEGE’S __EMS___Program ("Program");
NOW, THEREFORE, with regard to the Program, the parties agree as follows:
1.Pursuant to Section 1.3 of the Agreement, CHIPPEWA VALLEY TECHNICAL
COLLEGE’S Educational Coordinator for the Program shall be DeWayne Hanson.
2.Pursuant to Section 1.6 of the Agreement, all Students who are assigned to the Clinical
Education Setting shall have had a background check performed under the direction of CHIPPEWA
VALLEY TECHNICAL COLLEGE in accordance with applicable Wisconsin Caregiver Background
Check Law. The background check shall include obtaining, as applicable, information from the
Department of Justice, the Department of License and Regulation, the Department of Health and
Family Services and from out-of-state agencies if the Student has lived outside of Wisconsin within the
past three years. If the Student has a criminal record, it will be evaluated by CHIPPEWA VALLEY
TECHNICAL COLLEGE to determine if the individual is barred from performing duties at the Clinical
Education Setting. Prior to placement of the Student, CHIPPEWA VALLEY TECHNICAL COLLEGE
will notify the Clinical Education Setting in writing of any crime of which Student has been convicted so
that the Clinical Education Setting may make a determination as to whether the conviction(s) is
substantially related to the duties the Student would be performing. The Clinical Education Setting may
refuse placement of any Student the Clinical Education Setting believes could put its patients,
employees and/or visitors at risk. CHIPPEWA VALLEY TECHNICAL COLLEGE hereby agrees to
notify the Clinical Education Setting when CHIPPEWA VALLEY TECHNICAL COLLEGE becomes
aware that any Student on site at the Clinical Education Setting is charged with or convicted of any
crime or is investigated by any governmental agency. Both CHIPPEWA VALLEY TECHNICAL
COLLEGE and the Clinical Education Setting understand that the Student has an ongoing duty to
report to CHIPPEWA VALLEY TECHNICAL COLLEGE should there be any change from the initial
background check.
3. Pursuant to Section 2.2 of the Agreement, the Clinical Education Setting's Site
Coordinator shall be DeWayne Hanson.
4. Pursuant to Section 2.4, responsibility for qualified supervision shall be as follows:
Clinical Instructors assigned to the Program will be responsible for provision, coordination and
supervision of the clinical instruction, and the experience to be provided by Clinical Education Setting to
the Students enrolled in the Program. Clinical Instructors will be licensed by the State of Wisconsin in
Clinical Affiliation Agreement for Health Occupations 11
good professional standing with at least one (1) year of experience as license equivalent for student’s
Training Center Training Permit they are precepting or such higher number of years' experience as
requested by accreditation agencies, and have such other qualifications and experience as agreed to
by CHIPPEWA VALLEY TECHNICAL COLLEGE’S and Clinical Education Setting, or as required for
Program accreditation by accrediting agencies and authorities.
5. Pursuant to Section 2.7 of the Agreement, the clinical component offered by
CHIPPEWA VALLEY TECHNICAL COLLEGE shall in all respects be implemented and administered by
the Clinical Education Setting in a manner that meets the requirements of any accreditation agency that
accredits the Program, including the CAAHEP and CoAEMSP .
6. Pursuant to Section 3.1 of the Agreement, the Clinical Education Setting shall provide
the following additional feedback to the Program: Evaluation of clinical performance by enrolled
Students at the Clinical Education Setting will be the responsibility of the Clinical Instructors and the
Clinical Education Setting. The Clinical Instructors will participate in evaluation of the Student through
written communication. It is the responsibility of the Clinical Instructors to notify CHIPPEWA VALLEY
TECHNICAL COLLEGE of performance of a Student that is less than satisfactory in a timely manner so
that appropriate remediation may be initiated by the Clinical Education Setting, and if necessary, other
action taken with the assistance of CHIPPEWA VALLEY TECHNICAL COLLEGE. CHIPPEWA
VALLEY TECHNICAL COLLEGE, following review of written reports and input from the Clinical
Education Setting concerning Student performance and coursework in the Program, will assign the final
Pass-Fail grade to the Student for each clinical internship.
7. Pursuant to Section 6.1, the Agreement shall continue for an initial term of one Program
year ending on May 21, 2026,
8.All other terms of the Agreement shall apply, as applicable, to the Program and this
Program Addendum.
9. This Program Addendum shall be effective as of the date first written above and shall
continue in full force and effect for so long as the Agreement remains in full force and effect unless this
Program Addendum is (a) terminated prior to termination of the Agreement pursuant to Section 6.2 of
the Agreement, or (b) superseded by the execution of an amended and/or restated Program
Addendum.
IN WITNESS WHEREOF, the parties have executed this Program Addendum to the Affiliation
Agreement for Health Occupations as of the Effective Date.
CHIPPEWA VALLEY TECHNICAL
COLLEGE:
By:
Its:Executive Dean of Allied Health &
Emergency Service
Date: __5/21/2025__________________
CLINICAL EDUCATION SETTING:
By:
Its:
Date:
Revised: 2/1/2018