Affiliation Agreement Procedure

Processing Affiliation Agreements

All clinical affiliation agreements for any program at Texas Woman’s University (TWU) are processed through the Office of the General Counsel (OGC). The legality of the agreement is reviewed in this Office, but individual departments must determine if their faculty and students can abide by the requirements indicated on the agreement.

The OGC does not initiate contact with any facility about acquiring any agreements. Individual departments must initiate contact with desired facility and determine if the facility will accept the “TWU Standard Form Affiliation Agreement” for their program or if the facility prefers to use its own agreement. If the facility prefers to use their own, please see if they are willing to forward an electronic “Word” document; if necessary, it is much easier and faster to make changes!

Official Signatory for TWU Affiliation Agreements

Pursuant to TWU University Policy 2.26, Dr. Carolyn Kapinus, Interim Provost and Vice President for Academic Affairs, is the official signatory for TWU’s affiliation agreements; therefore, her name and title should be reflected in the signature block of all clinical affiliation agreements. Her contact information is as follows:

Dr. Carolyn Kapinus
Interim Provost and Vice President for Academic Affairs
P. O. Box 425617
Denton, TX 76204
(940) 898-3301
(940) 898-3306 – Fax

Note: All agreements must also be reviewed and signed and/or initialed by the program dean/director prior to forwarding the affiliation agreement(s) to the General Counsel for review and signature.

If Prospective Facility Provides an Electronic Document

If a facility provides an affiliation agreement in electronic format, “Word” is preferred. Prior to forwarding the agreement via email to the OGC:

  • Make sure to forward contact information for the facility, such as the name of the person that you have been in contact with and that is to receive the agreement(s), the complete mailing address of the facility, telephone number, fax, email, etc. If the contact information is handwritten, please make sure that it is legible.
  • Indicate if the facility accepts an electronic, signed documents or if they prefer hard copies. If hard copies are preferred, indicate how many must be returned to the facility.
  • Make sure the facility has filled in any blanks pertaining to their facility, such as contact information for notices, including the name of the person that handles affiliation agreements, the complete mailing address, telephone number, fax, email, etc., and any other pertinent information.
  • Fill in any blanks that pertain to your departmental program, such as program name, program dean/director, number of students participating, address of program for notices, etc., and any other pertinent information. 

If electronic documents are acceptable, most facilities will request that they be signed with blue ink.

If Prospective Facility Does Not  Provide an Electronic Document

If the facility does not provide an electronic document and wishes to use its own agreement, provide the facility with the following:

  • Your departmental contact information for notices, such as the name of the person that handles affiliation agreements for your department, the complete mailing address of your department, telephone number, fax, email, etc., and any other pertinent information regarding your program.
  • The General Counsel’s name and title for the signature block and, if needed, the complete mailing address of the General Counsel, telephone number, fax, email, etc., as indicated above.

If electronic documents are not accepted, forward at least two (2) original affiliation agreements for processing, whether it is the TWU Standard Form Affiliation Agreement for your program or the facilities agreement. A fully-executed affiliation agreement MUST be kept on file in the OGC and, generally, the facility requires at least one (1) fully-executed agreement as well. 

Once Received by the OGC

Each affiliation agreement will be assigned an identification number. Please use this number when inquiring about the status of an affiliation agreement.

The affiliation agreement will be reviewed by the General Counsel to determine if the agreement will be signed as is or if the negotiation process will begin between the facility and TWU.

If there are revisions to the affiliation agreement, the OGC shall return the revised contract to the facility for their review and approval of the OGC’s changes. If approved, the authorized representative from the facility must accept the revisions, sign and return the revised affiliation agreement to the OGC.

If the facility has additional revisions, their revisions must be forwarded back to the OGC for review/approval. If OGC approves the facilities revisions, the OGC will sign the agreement and return it to the authorized representative from the facility to execute the affiliation agreement.

Periodically, the OGC will send an updated listing of affiliation agreements processed throughout the fiscal year and a final listing at the end of the fiscal year. The OGC keeps a log of all the affiliation agreements forwarded for review, approval, and signature. The listing includes the TWU-assigned number for each affiliation agreement, the name of the facility, the TWU department/program requesting approval/signature, the type of agreement (TWU Standard Form Affiliation Agreement or facility), the facility location, the date the agreement was signed and sent to the facility or to the TWU department/ program, the term of the agreement, and the status of the agreement.

Generally, a reminder letter will be sent to the facility approximately one month from the date the agreement was originally sent to the facility for approval/signature from the OGC. It will be up to the individual department to contact the facility thereafter to obtain a signed agreement.

Receipt of Fully-Executed Affiliation Agreements

If an original, fully-executed affiliation agreement is sent directly to your department, please make a copy for your files and forward the original to the OGC.

If the original, fully-executed affiliation agreement is sent directly to the OGC, a scanned, electronic copy will be forwarded to you for your departmental file.

Please have departmental faculty and/or staff contact the departmental/program coordinator to check on the status of an affiliation agreement and to obtain copies of said affiliation agreements.

If the departmental coordinator does not have a fully-executed affiliation agreement and in an effort to expedite locating an affiliation agreement, please provide the OGC with the TWU-assigned number, the complete name of the facility, including the “umbrella” corporate name, if necessary, and the approximate fiscal year that the agreement was processed or signed.

TWU Standard Form Affiliation Agreement [doc]

Page last updated 11:48 AM, June 6, 2019