Affiliation Agreement Request

If you are an RHCHP student who wishes to be affiliated with an agency that requests a contract, please fill out and submit this form. All fields are required.

After you submit your form, we will follow up with the agency. Completed Affiliation Agreements must be in place prior to your course start date and often take over 3 months to complete. 

Please submit Affiliation Agreement requests at least 90 days in advance to increase the likelihood the agreement will be complete prior to your course start date.

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