Clinical affiliation agreements: what students need to know

What an affiliation agreement is

An affiliation agreement is the contract that lets a school send its students to train at a clinical site. You may hear it called a clinical agreement, an educational affiliation agreement, a memorandum of understanding or simply the contract. The standards for nurse practitioner education describe it as a formal agreement between an education program and a clinical agency that protects the site, the program and students during educational experiences.

The agreement is usually made between the school and the site as organizations, not for one student. Once it is signed, it can cover many students from the same school, often across several terms. PA accreditation standards even define an active clinical site as one with a current affiliation agreement that is available to accept students.

Some programs also use a separate preceptor agreement, which the individual preceptor signs to confirm their role. That is a different document from the affiliation agreement, and your school may need both.

Who signs it

Two organizations sign: your school and the clinical site. On the school’s side, the signer is usually a dean, a clinical placement office or the school’s contracts office. On the site’s side, it is a person authorized to sign contracts for the facility. In a small practice, that may be the practice owner, a practice manager or an administrator. In a large health system, the agreement often goes through a legal or contracts team and a student placement or education office.

PA accreditation standards spell out that agreements are signed by an authorized individual of each participating organization. As a student, you do not sign the affiliation agreement itself, though the site may ask you to sign its own forms, such as a confidentiality statement, during onboarding.

What it usually covers

Every agreement is written differently, but most cover the same topics. In plain words, they usually say:

How long it can take

Timelines vary from site to site. A small practice that accepts the school’s standard agreement may sign within weeks. A large health system often uses its own template, routes the agreement through its legal and education offices and reviews requests in order, so it can take longer. Each round of edits between the two organizations adds time too.

That is one of the main reasons schools ask students to secure a preceptor one to two terms before the course. Starting early gives the agreement time to move at its own pace while you finish everything else.

Sites that already have an agreement with your school

If your school already has a current agreement with your site, the process is much shorter. Your school confirms that the agreement is active and covers your program, and you move straight to preceptor approval and onboarding.

It is still worth checking the details. An agreement may cover some programs and not others, for example nursing but not counseling, or some locations of a health system and not all of them. Your clinical coordinator can confirm whether the existing agreement covers your placement.

What you can do

You do not write or sign the agreement, but you can help it move smoothly:

1. 1Start earlyBegin your preceptor search one to two terms ahead, and raise the agreement as soon as a preceptor says yes.
2. 2Ask whether one already existsYour school’s placement office can tell you whether it has a current agreement with the site.
3. 3Connect the right peopleGive the site your school’s contact for agreements, and give your school the name and email of the site’s authorized signer or contracts office.
4. 4Respond quicklyIf either side asks you for information, such as the site’s legal name or address, send it the same day.
5. 5Track the statusKeep a short log of when the agreement was sent, who has it now and the next step, and check in with your coordinator regularly.
6. 6Finish onboarding in parallelGather your immunizations, TB screening, BLS and other documents while the agreement is in review, so you are ready the day it is signed.
7. 7Wait for the go-aheadBegin your clinical hours only after your school confirms the agreement and your approvals are complete.

Agreements in counseling, social work and behavior analysis

Other programs add their own written agreements. Counseling programs accredited under the CACREP 2024 standards use written supervision agreements that define the roles of the faculty supervisor, the site supervisor and the student, include emergency procedures, and set how often the program and the site consult.

Social work programs follow a set process for identifying, approving and engaging field settings under CSWE’s standards, and your learning agreement sets out what you will do in the placement. Behavior analysis trainees and their supervisors sign a supervision contract before any fieldwork hours begin, outlining the responsibilities of each person.

Renewals and changes

Agreements last for a set term and are renewed or updated over time. Some renew on their own and others are signed again. Your school tracks these dates for its sites, so you rarely need to do anything, though it is a good question to ask if your placement runs across several terms.

A new agreement may be needed when something changes: the site joins a new health system or changes its name, your preceptor moves to a different practice, or you add a new location. If your preceptor tells you about a change like this, let your clinical coordinator know right away so the paperwork can follow.

Questions students ask