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This document outlines the responsibilities and agreements between the school, trainees, and supervised fieldwork settings for the purposes of accruing clinical hours necessary for licensure as a
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How to fill out 4-Way Affiliation Agreement between the Qualifying Degree Program, Fieldwork Setting, Supervisor, and Trainee

01
Obtain the 4-Way Affiliation Agreement template from the relevant authority.
02
Identify the Qualifying Degree Program and ensure all details are accurate.
03
Include the Fieldwork Setting information, making sure to specify the location and any relevant details.
04
Designate a Supervisor from the Fieldwork Setting, including their qualifications and contact information.
05
Fill in the Trainee's details, ensuring to include their full name and program information.
06
Review the agreement for completeness and accuracy, checking that all parties’ roles are clearly defined.
07
Ensure all parties (Qualifying Degree Program representative, Fieldwork Setting representative, Supervisor, and Trainee) sign the agreement.
08
Keep copies of the signed agreement for all parties involved.

Who needs 4-Way Affiliation Agreement between the Qualifying Degree Program, Fieldwork Setting, Supervisor, and Trainee?

01
Students enrolled in a Qualifying Degree Program seeking fieldwork experience.
02
Educational institutions offering Qualifying Degree Programs.
03
Fieldwork settings that provide practical experience for students.
04
Supervisors overseeing the training of students in a fieldwork setting.
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The 4-Way Affiliation Agreement is a formal contract involving a Qualifying Degree Program, a Fieldwork Setting, a Supervisor, and a Trainee. It outlines the responsibilities, expectations, and obligations of each party to ensure a structured and beneficial learning environment during the trainee's field experience.
The parties required to file the 4-Way Affiliation Agreement include representatives from the Qualifying Degree Program, the Fieldwork Setting organization, the Supervisor overseeing the trainee, and the Trainee themselves. All parties must agree to the terms set forth in the agreement.
To fill out the 4-Way Affiliation Agreement, each party must provide their respective information, including the names and titles of representatives, contact information, and the specific details regarding the fieldwork setting and the trainee's role. All parties must review the agreement to ensure accuracy and mutual understanding before signing.
The purpose of the 4-Way Affiliation Agreement is to establish clear guidelines and responsibilities for each party involved in the trainee's educational experience. It helps to ensure that the trainee receives appropriate supervision, learning opportunities, and support from both the academic and practical settings.
The information that must be reported on the 4-Way Affiliation Agreement includes the names and contact details of all parties involved, the duration and scope of the trainee's fieldwork, specific roles and responsibilities of the Supervisor and the Trainee, as well as any additional terms or conditions relevant to the placement.
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