Health Care Management Major
Letter of Agreement Form
This agreement is entered into this _____ day
of __________, 20___ between Towson University, an agency of the State
of Maryland (hereinafter referred to as "the University"),and_________________________________(hereinafter
referred to as the "Agency"). The Letter of Agreement shall govern the
use of the Agency's facilities by the faculty and students enrolled in
the University Bachelor of Science Degree Program in Health Care Management.
The Agency identified above agrees to the following
conditions in accepting and supervising the University's Health Care Management
interns:
(1) A description of the Agency must be submitted
to the University for inclusion in the Internship
Site directory;
(2) Notification must be made in advance to the
University Health Care Management Internship
Coordinator when (a) a semester become inappropriate for fieldwork experiences, (b) when there
is a change in supervisory personnel and/or (c) when the agency
supervisor(s) will be on leave of absence;
(3) The Agency must, at all times, provide adequate
supervision. The intern should not replace any employee or assume unsupervised
command of any project or role;
(4) The Agency informs the intern
at
the time of the interview regarding reimbursement
policies for on-the-job travel, liability coverage, parking, immunizations, criminal background check
or other job related expenses;
(5) The intern should be provided oral and/or written information ( e.g. annual
reports, description of the agency's goals, organizational charts, nature
of the placement, anticipated tasks of the intern, working conditions) about the agency to assist the intern in making an informed decision when selecting an internship placement. This exchange must be done at the time of
the interview.
(6) The Agency supervisor must:
(a) have a minimum of one year in her/his current position
(b) be responsible for a health care management project or component of a larger
health care management in the Agency
(c) have experience in health care management
and/or related fields as well as
supervisory experience
(d) be committed to and have sufficient time to devote
to the professional growth and development of the intern.
(e) agree to interview potential interns.
(f) consent to complete the Internship Request Form and return it to the University's Health Care Management Internship Coordinator
after interviewing the prospective intern (g) agree to meet with the University's Health
Care Management Supervisor on a periodic basis and as needed to discuss
the intern's progress (h) agree to complete al intern evaluation forms
(i) agree to provide daily supervision for
the intern.
This Letter of Agreement binds both the University
and the Agency to the requirements specified in the Health Care Management Internship
Handbook. Should either party be desirous of terminating this Agreement,
prior notice must be given sixty (60) calendar days in advance of
its termination. Such termination shall not take effect, however, until interns already engaged in the Agency have complete their internship experience. If no termination by either side is sought, the
Agreement will be in effect until __________________________.
During the performance of this agreement it is
agreed that there will be no discrimination against any student because
of race, color, religion, gender, sexual orientation or national origin.
AGENCY
____________ ________________________________________
Date Agency Administrator
____________ ________________________________________
Date Agency Supervisor
TOWSON UNIVERSITY
___________ _________________________________________________
Date Sharon Buchbinder, Department of Health Science, Chairperson
____________ ________________________________________
Date Susan Casciani, Health Care Management Internship Coordinator
Department of Health Science
Burdick Hall, Room 141
Hours: Monday–Friday, 8:30 a.m.–5 p.m.
Phone: 410-704-2637
Fax: 410-704-4670
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