MS Med-SLP Program

STUDENT AGREEMENT FOR PARTICIPATION

 IN CLINICAL EDUCATION EXPERIENCES

 

The Student agrees to the following:

 

  1. Participate fully in clinical education during hours that the facility designates and arrange for personal schedules to allow for regular/required hours as required by the facility/Clinical Instructor (CI).
  2. Notify the University and the CI in advance of the time the student is scheduled to arrive for work if the student will be unable to report as scheduled.
  3. Conform to the policies, procedures, rules and regulations of the facility and the University.
  4. Maintain Professional behavior at all times including taking responsibility for their own learning, seeking opportunities and taking initiative for educational experiences, accept and implement feedback; to be honest, courteous, cooperative and punctual, and to exhibit proper dress, grooming and health habits.
  5. Consult the CI, CCCE, or DCE about any difficulties arising at the Facility.
  6. Submit promptly to the DCE all information and reports required by the University.
  7. Indemnify and hold harmless the Facility and its officers, employees, agents and other representatives from and against liability for damages, claims, lawsuit, judgments, expenses and attorney’s fees which may be incurred by the Facility or the CI resulting from any acts or omissions of the Student.
  8. Maintain individual health insurance to cover any injuries or illnesses that might arise as a direct or indirect result of your work at the Facility.
  9. Strictly protect the confidentiality of all records and information belonging to the Facility, its personnel and patients, including its methods of operation and business and all information that could be considered proprietary or that might be contrary to HIPAA policies.
  10. Inform all patients that you are a MS Med-SLP student from RMUoHP and that the patients have a risk free right not to participate in clinical education.

 

Printed Name    ___________________________________________

 

Student’s Signature: Date:

 

 

Printable Student Agreement Form