Creighton University Student ProgramSHORT-TERM OR SINGLE SESSION AFFILIATION AGREEMENT BETWEEN
CREIGHTON UNIVERSITY
AND
Agency Name: CITY OF BLAIR POLICE DEPARTMENT
This agreement is entered into by Creighton University, a Nebraska nonprofit corporation located at 2500
California Plaza, Omaha, NE 68178 ("Creighton") and CITY OF BLAIR POLICE ("Agency").
1. Creighton, through its School of Pharmacy and Health Professions, offers accredited
programs in Pharmacy, Occupational Therapy and Physical Therapy ("Programs") and desires to have its
enrolled students ("Students") engage in a short-term or single session educational experience
(` Experience(s)") at Agency.
2. Agency is willing to make its facilities available to Creighton for these Experiences to
students enrolled in Creighton's Programs.
AGREEMENTS
(1) Experience areas dates, times, and numbers of students will be mutually agreed upon prior to a
student beginning an Experience. Creighton Faculty will be responsible for selecting the
Experiences, subject to approval by the Agency, and will assume full responsibility for the
educational instruction of its students. Agency assumes responsibility for the supervision of
educational experiences on site, either with or without direct Creighton faculty involvement.
Students shall be directly responsible to the designated Creighton faculty.
(2) Creighton students and faculty shall wear Creighton issued name tags while in the Agency unless
requested to do otherwise by the Agency.
(3) Creighton shall ensure that all students:
a. Have had a PPD test and are current in their immunizations. Immunization shall include
Hepatitis B and/or a signed waiver declining the vaccine. In no event shall Creighton enroll a
student for an Experience who Creighton has reason to believe has contracted a
communicable disease and is in the communicable period.
b. Have submitted to a complete background check and the results have been satisfactory to
Creighton for purposes of admission into the School.
(4) Creighton shall provide worker's compensation coverage for its employees while on Agency
premises. During the term of this Agreement, Creighton shall keep in full force professional
liability insurance in the amount of $1,000,000 per occurrence and $3,000,000 in the aggregate.
(5) Creighton students and faculty will adhere to all of the Agency's policies and procedures while
within the Agency.
(6) The Agency has the right to take immediate action where necessary to maintain operation of its
facilities free from interruption, and to terminate a student's Experience and use of its facilities,
equipment or supplies where flagrant or repeated violations of the Agency's rules, regulations,
policies or procedures occur. Such action will not normally be taken until the charges against the
student have been discussed with the appropriate representative of Creighton. Creighton will not
reassign the individual to the Agency without prior approval of Agency, which will not be
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unreasonably withheld.
(7) As required by law, neither the Agency nor Creighton shall discriminate against any employee,
applicant or student for employment or registration in its course of study because of race, color,
religion, sex, national origin, handicap, special disabled veteran's status or Vietnam era veteran's
status. Both parties agree to comply with the Educational Rights and Privacy Act of 1974, as
amended, by maintaining confidentiality related to student performance while on site and of
student records maintained by Creighton and, if applicable, the Agency.
(8) This agreement is intended to jointly benefit both parties by improving education and Agency's
services. Neither party is expected to provide payment or remuneration to the other.
(9) This Agreement will become effective on OCTOBER 6TH 2016 , and
remain in effect unless terminated by either party by written notice given to the other party at
least ninety (90) days in advance of such termination. Any students participating in an
Experience at the time of the notice shall be allowed to complete the Experience.
Agency Name: CITY OF BLAIR POLICE DEPARTMENT
Signature:
Name: J
Title: CITY OF BLAIR MAYOR
Signatr
Name:
Date: 10/6/2016
Title: CHIEF OF POLICE
Signature: " , k
Victoria F. Roche, Ph.D
Senior Associate Dean
School of Pharmacy and Health Professions
Creighton University
Date: 10/6/2016
Date:/ -
Signature: Date: )a 11% I1lPDr. Ann Ryan Haddad
Director, Office of Interprofessional Scholarship, Service and Education
School of Pharmacy and Health Professions
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Agency Mailing Address:
Name: CITY OF BLAIR POLICE DEPARTMENT
Department: POLICE
Address: 1730 LINCOLN STREET
BLAIR, NEBRASKA 68008
CONTACT Name: JOSEPH LAGER
Title: CHIEF OF POLICE
Phone: 402-426-4747
Creighton University Mailing Address:
Creighton University
School of Pharmacy & Health Professions
The Office of Interprofessional Scholarship,
Service and Education (OISSE), 113 Boyne
2500 California Plaza
Omaha, NE 68178
CONTACT: Kate Martens Stricklett
OISSE Education Coordinator
(402) 280-5258
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