Va Form 10-0094d - Dental Education Affiliation Agreement Between Department Of Veterans Affairs (Va) And A School Of Dentistry As The Sponsoring Institution - 2015
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7DENTAL EDUCATION AFFILIATION AGREEMENT
BETWEEN DEPARTMENT OF VETERANS AFFAIRS (VA)
AND A SCHOOL OF DENTISTRY AS THE SPONSORING INSTITUTION
Use when dental trainees are enrolled in an academic program accredited by the Commission on
Dental Accreditation (CDA) and the accreditation is in the name of the dental school
VA NETWORK
VA HEALTHCARE FACILITY (including city and state)
SCHOOL OF DENTISTRY (including city and state)
AFFILIATED INSTITUTION # 1 (including city and state)
AFFILIATED INSTITUTION # 2 (including city and state)
This agreement, when duly executed and approved by the Department of Veterans Affairs (VA), establishes
an affiliation between VA, its Veterans Integrated Service Networks, the listed VA facilities, the school of
dentistry and its affiliated participating institutions for the academic purposes of enhanced patient care, education,
and research. Dental schools and their affiliated institutions that are signatories to this document are collectively
referred to as “affiliated institutions” or “the affiliate.” All parties to the agreement have a shared responsibility
for the academic enterprise. The affiliating institutions accept primary responsibility for the integrated education
programs conducted with VA while VA retains full responsibility for the care of VA patients and administration
of its healthcare system. Additional responsibilities are delineated below.
BACKGROUND
The provision of education for future healthcare providers and the conduct of research are VA statutory
missions. By virtue of the close relationships between VA and the nation’s academic institutions, VA plays a
leadership role in shaping the education of future healthcare professionals meet the complex scope of the nation’s
healthcare delivery system. It is the intent of VA to maintain its long-standing practice of effective affiliations
with educational institutions for the purposes of continued excellence in VA patient care and conducting joint
academic programs that address health manpower needs for VA and the nation.
VA FORM 10-0094d
June 2015
PAGE 1 OF 6
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