UNIVERSITY OF NEBRASKA MEDICAL CENTER
COLLEGE OF PHARMACY
VOLUNTEER CLINICAL FACULTY (Unpaid Special Appointment)
AGREEMENT AND RELEASE FORM
This Agreement is made and entered into this day of, 20, by and between the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA, a public body corporate, for and on behalf of the University of Nebraska Medical Center, hereinafter called "UNMC" and, hereinafter called "Volunteer".
1. Volunteer agrees that s/he is volunteering solely for personal, civil, charitable or humanitarian purposes without promise or expectation of compensation, benefits or future employment from the UNMC beyond any specified reimbursement agreements through The Nebraska Medical Center (TNMC). Volunteer understands that his/her relationship with the UNMC carries with it no promise of continuation and can be terminated in accordance with the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA Bylaws (Bylaws) and the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA Policies (Policies).
2. The professional staff appointment status of Volunteer shall be a Special Appointment at the rank of Adjunct enter rank (clinician) in the Department of Pharmacy Practice. The term of Volunteer’s Special Appointment shall begin on and is subject to Section 4.4.1 of the Bylaws.
3. Volunteer will perform services in association with their TNMC employment and under the direction and control of UNMC faculty.
4. Volunteer agrees to perform the teaching, service, and research duties and responsibilities set forth in the written statement attached to this Agreement as Appendix “A” and incorporated herein by reference. Volunteer and UNMC agree that Appendix A shall be periodically reviewed and revised as appropriate in accordance with the Bylaws.
5. Volunteer agrees to follow the directions of UNMC faculty with respect to all training programs and to abide by Bylaws and the Policies while carrying out these volunteer services. Volunteer understands that s/he may be subject to criminal background checks or other prescreening checks, if applicable. Volunteer acknowledges that s/he has been informed of the aforementioned Bylaws and Policies. Bylaws can be found at www.nebraska.edu/board/board_bylaws.shtml. Policies can be found at www.nebraska.edu/board/board_policies.shtml).
6. Volunteer acknowledges that s/he is not an employee of the UNMC, and is not entitled to receive salary, benefits or other compensation. Volunteer understands that s/he does not qualify for worker’s compensation benefits through UNMC, and is expected to carry group or personal medical insurance to cover medical expenses for any injury s/he may incur while performing services voluntarily for the UNMC.
7. So long as Volunteer is acting within the course and scope of his/her volunteer assignment, UNMC, through its self-insurance program, will provide a legal defense if someone outside the UNMC brings a claim against Volunteer for acts performed by Volunteer in good faith and as part of his/her UNMC responsibilities.
8. As a condition of initial and continued volunteer status, Volunteer will immediately apply for, obtain and maintain, at all times during the term of this Agreement, a full and unrestricted license to practice pharmacy in the state of Nebraska. Volunteer’s inability to obtain or maintain such license may subject Volunteer to immediate termination of this Volunteer Agreement.
9. As a condition of initial and continued volunteer status, Volunteer will immediately apply for obtain and maintain an unrestricted Drug Enforcement Administration license to prescribe controlled substances at all times during volunteer status with UNMC. Volunteer’s inability to obtain or maintain such license may subject Volunteer to immediate termination of this Volunteer Agreement.
10. If Volunteer is not a citizen or permanent resident of the United States, Volunteer certifies that s/he has appropriate visa status that authorizes Volunteer to be present in the United States and allows Volunteer to participate in this volunteer experience.
11. Professional liability insurance will be maintained by The Nebraska Medical Center
12. This Agreement shall be construed and enforced in accordance with, and is subject to the Bylaws and Policies as well as the laws of the State of Nebraska.
13. The parties agree that this is the entire Agreement between them and that no Agreement, either oral or written, exists outside this Agreement regarding the volunteer services described in this Agreement.
VOLUNTEER RELEASE
Volunteer releases the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA, its officers, employees, agents, representatives and assigns, from any responsibility or liability for personal injury, including death, and the damage to or loss of property, that Volunteer may incur due to the negligence of the BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA, its officers, employees, agents, representatives and assigns or others due to accidental occurrences while visiting the UNMC or otherwise engaging in activities contemplated by this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
ACCEPTED:
By: ______this ______day of ______, 20____.
Faculty Member
APPROVED:
By: ______
Date
Department Chair THE BOARD OF REGENTS OF THE
UNIVERSITY OF NEBRASKA
By: ______By: ______
Dean, College of Pharmacy Date Vice Chancellor for Academic Affairs, UNMC Date
Attachment: Appendix “A”
Volunteer Faculty Agreement Faculty Initials ______
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