Download Affiliation Agreement

Affiliation agreements are legal documents that must be in place before an intern can start working at a facility. The Affiliation Agreement is a simple agreement whose purpose is to outline in writing the relationship between the three parties (facility, New York Distance Dietetic Internship, and the intern).

Once the intern has made arrangements with the preceptor, the next step is to follow up with an Affiliation Agreement.

Interns must provide the proper names, titles, mailing address, email address, contact phone, dates, and related information. Accuracy and spelling are critical.

There are a few nuances regarding Affiliation Agreements interns needs to be aware of before starting rotations.

Once the rotation begins, should an intern choose a new or different preceptor and/or facility, then the intern will need to complete new preceptor, facility, and affiliation agreements.

A facility where an intern plans on working more than one week must submit a signed affiliation agreement by both parties and a completed preceptor facility form.

For a rotation shorter than one week, an email communication between NYDDI and the facility is required stating an affiliation agreement is not warranted due to the short duration of the rotation. A completed preceptor facility form is required.

  1. If an intern makes arrangements with a Consultant Dietitian the intern still needs the preceptor form with the consultant, the facility form, and affiliation agreements – with each location the Consultant works where you will be working.
  2. If the intern is working at a facility less than one week, but not completing assignments at that facility e.g. filling in a missing week; an affiliation agreement can be waived, provided that an email is sent attesting to the arrangements.
  3. If the intern works five or more days, a separate preceptor and facility form along with an affiliation agreement is required.

If in doubt check with NYDDI.

One last comment about facilities and preceptors. An intern may not begin a rotation until all the required documentation is in place.

  • Preceptor Profile and Facility form
  • Affiliation Agreement