Arizona Living Well Institute Partner Agreement

Purpose

Arizona Living Well Institute (AZLWI) is a program ofEmpowerment Systems, Inc.’s 501(c)3 nonprofit family of health education and multi-dimensional wellness programs. The mission of AZLWI is to “advance evidence-based programs for Arizona communities through structured communication, multi-level coordination and facilitator coaching.” Under contract with the Arizona Department of Health Services, Empowerment Systems operates AZLWI, the statewide hub committed to sustaining an efficient and effective system delivering the Self-Management Resource Center’s (SMRC) evidence-based Chronic Disease Self-Management Education (CDSME). AZLWI maintains a system and infrastructure for training, credentialing, and mentoring CDSME workshop leaders, coordinating delivery of CDSME programs, supporting an electronic referral system, gathering and managing data and providing technical assistance to ensure fidelity and successful CDSME implementation throughout Arizona. The Partner Agreement is to delineate the responsibilities of AZLWI and each Partner of the Healthy Living Partner Consortium. A clear description of the roles and responsibilities can be found at Initial here _____ stating you understand the roles and responsibilities of each party.

The Partner Agreement names the Partner as a member of the Healthy Living Partner Consortium with authorization to facilitate CDSME, either under theMultiple Program License for Internal Use, issued by SMRC to AZLWI or the Partner’s license with SMRC. This agreement also applies to any organization working under the Partner’s license.

The initial investment fee in the Healthy Living Partner Consortium is $100 and includes the following benefits:

  • Access to the Community Referral Network and specialized reports
  • New referrals into workshops
  • Access to the expertise of Regional Mentors
  • Participation in regional collaborative meetings
  • Priority access to register for upcoming trainings
  • Fidelity monitoring
  • Technical assistance
  • Increased educational opportunities

The Partner Agreement will be in place for one (1) fiscal year, July 1st, 2017 to June 30th, 2018. Either party may terminate this agreement upon thirty (30) days’ prior written notice.

Revised 11/17/17

IN WITNESS WHEREOF, AZLWIand Partner have executed this agreement:

Revised 11/17/17

Partner

______

Print

______

Sign

______

Date

Empowerment Systems, Inc.

______

Print

______

Sign

______

Date

Revised 11/17/17