Download Joint Provider Agreement (Template)

Joint Provider Agreement
Joint Providership means that two or more organizations work together to plan and implement
a continuing nursing education activity. The organization submitting the application to MNA is
the provider; other organization(s) is/are joint provider(s).
The nurse planner from the provider organization is responsible for leading the planning team
and is accountable for assuring adherence to accreditation program criteria. A representative of
the joint provider organization must be a member of the planning committee for the activity. In
marketing and learning materials, names of both organizations may be used, but the provider’s
name must be prominent.
Note: Organizations providing commercial support or sponsorship may not provide or
jointly-provide an educational activity
Title of Educational Activity:
Activity Date:
Organization Providing Activity:
Joint Provider:
Terms and Conditions
1. This activity is for educational purposes only and will not promote any special interest of a joint
provider.
2. The Provider of the Activity is responsible for the following aspects of the activity:
 Determining objectives and content
 Selecting planners, presenters, and anyone else involved with the educational activity.
 Awarding contact hours
 Recordkeeping procedures
 Developing evaluation methods
 Managing commercial support or sponsorship
3. The following stipulations apply:
 The nurse planner of the activity applicant must lead the planning committee.
 A member of the joint provider organization must serve on the planning committee.
4. Other terms of agreement between the provider and joint provider:
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MNA Joint Provider Template
8/15/14
Attestation to the agreement:
Provider of the Activity
(name of organization):
Address:
Email Address:
Phone Number:
Nurse Planner Signature (Required):
Date:
Joint Provider (name of
organization):
Address:
Name of Representative on
Planning Committee:
Email Address:
Phone Number:
Authorized Signature (Required):
MNA Joint Provider Template
Date:
8/15/14