MEMORANDUM OF AGREEMENT

(Institution and Student Intern re: Related Learning Experience (RLE) )

This Memorandum of Agreement (hereinafter “Agreement”) is made and entered into on

____ day of _______20____ in the City of Cebu Philippines by and between:

SOUTHWESTERN UNIVERSITY PHINMA (SWU), an educational institution

duly organized and existing under and by virtue of the laws of the Republic of the
Philippines, with main address at Urgello St., Sambag 2 Cebu City represented
herein by its Chief Operations Officer and Executive Vice President
MR. ALBERT L. GAMBOA herein referred to as the “Institution”
-and-
_________________________________ (Name of Student), a Bachelor of Science
in Nursing (BSN) student of the College of Nursing, Southwestern University, of
legal age, with address at _____________________________________ (Address),
hereinafter referred to as “Student Nurse”.

Witnesseth—

WHEREAS, SWU instituted an Related Learning Experience (RLE) Rotation as part of

the curriculum for its Bachelor of Science in Nursing students in compliance to the requirement
of Commission on Higher Education (CHE) CMO 15 Series of 2017 and in order to provide them
with adequate actual Related Learning Experience (RLE).

WHEREAS, SWU-Phinma has been granted permission from the Commission on Higher
Education (CHED), Department of Health (DOH) and the Interagency Task Force (IATF) to
conduct Limited Face-to-Face Related Learning Experience (RLE) for the BS Nursing Student
Nurses.

WHEREAS, SWU, in its desire to enhance the training and development of more
professionals, has agreed to provide support to the BSN Student Nurses of SWU in ensuring
Related Learning Experience (RLE) in a CHED accredited Health Facility.

WHEREAS, SWU executed a Memorandum of Agreement that covers the internship

program’s objectives and principles pursuant to their established Related Learning Experience
(RLE) for the Student Nurse.

WHEREAS, the Student Nurse accepts this Agreement and the respective Related
Learning Experience (RLE) with all its terms and conditions as contained herein.

NOW, THEREFORE, for and in consideration of the foregoing premises, the Parties
hereby agree as follows:

SECTION I
Responsibilities of the Institution

a) The Institution shall undertake the selection of Affiliation Centers for Related Learning
Experience (RLE) recommended in accordance to existing policies and guidelines.

b) The Institution shall provide relevant instruction, exposure, and training to the Student
Nurse, consistent with its policies, rules and regulations and with the established Related
Learning Experience (RLE). It shall treat the Student Nurse in a professional manner, and
 shall ensure that the Student Nurse, in the course of Related Learning Experience (RLE) ,
shall not be exposed to any form of harassment/unethical practice or tasks and work
assignments that are unreasonably risky, dangerous or unrelated to the purposes of the Related
Learning Experience (RLE);

c) The Institution shall collect affiliation fees from the Student Nurse and ensure payment of
the same to the affiliation centers subject to reimbursement and liquidation policies of the
Institution;

SECTION II
Responsibilities of the Student

a) The Student Nurse shall have enrolled and completed prerequisite of professional nursing
subjects with Related Learning Experience (RLE) component.

b) The Student Nurse shall express his/her intention to enrol in the Related Learning Experience
(RLE) in compliance to the Curriculum Requirement as mandated by CHED CMO 15 Series of
2017 by entering into this MOA with the Institution.

c) The Student Nurse shall express his/her intention to join the Limited Face-to-Face Related
Learning Experience (RLE) and comply with all requirements stipulated in the CHED-DOH
Joint Memorandum Circular No.2021-001.

d) The Student Nurse shall divulge any relevant or existing health conditions to SWU College of
Nursing prior to the Related Learning Experience (RLE) rotation.

e) The Student Nurse shall abide by the administrative policies, rules, and standards of the
Institution and SWU as provided by the SWU Student Handbook and Related Learning
Experience (RLE) Guideline.

f) The Student Nurse shall accomplish and submit to the assigned SWU Related Learning
Experience (RLE) Clinical Instructor a weekly journal of activities, to include Performance
Notebook and Daily Time Record (DTR).

g) The Student Nurse shall accomplish the assigned tasks to the best of his/her abilities and
conform with the Related Learning Experience (RLE) set forth SWU and Institution;

h) The Student Nurse shall complete the agreed scope of work within the agreed duration of the
Program; and

i) The Student Nurse shall timely report for training and promptly accomplish assigned tasks or
assignments in the best of his/her ability and in view of his/her expected skill and knowledge.

j) The Student Nurse shall satisfactorily comply with all the requirements; and achieve a
competency level set-forth in the Related Learning Experience (RLE) Guideline.

k) The Student Nurse shall strictly observe health protocols and guidelines as imposed by the
DOH, LGU, SWU and SWUMed; and such other additional health protocols that the affiliation
center where the student-intern is assigned may require to make sure that infection can be
avoided.

l) The Student Nurse shall stay at home and report to the ASSISTANT DEAN any possible
exposure or manifestation of symptoms of COVID19.

m) The Student Nurse shall subject himself/herself to a COVID RT PCR nasopharyngeal swab
within 5 days to start of Related Learning Experience (RLE).
n) The Student Nurse undertakes to get himself/herself vaccinated, as soon as the vaccine is
available, unless by own freewill he/she refuses.

o) The Student Nurse shall treat other student-interns, clinic staff and patients as potentially
infectious, thus, must at all times, observe strict health protocols and physical distancing.

SECTION III
General Conditions

a) The SWU College of Nursing shall conduct a Pre-Related Learning Experience (RLE) and
Post - Related Learning Experience (RLE) evaluation.

b) The SWU College of Nursing and/or affiliation center shall assign groups, rotation
assignment and schedule of rotation and duties.

c) The Student Nurse shall report for his/her assigned duty shift at the Institution’s assigned
affiliation center which is inclusive of a one (1) hour break/lunch time and reasonable
morning/afternoon break-times not exceeding fifteen (15) minutes;

d) The SWU College of Nursing developed an Related Learning Experience (RLE) Rotation for
the Student Nurse that specifies objectives, knowledge, skills, and competencies that the
Student Nurse should acquire in each learning area, assignment, and/or activity covered by the
Related Learning Experience (RLE) attached herewith as Annex “A”;

e) The SWU College of Nursing will conduct a post-internship review and evaluation of the
program and the performance of the Student Nurse;

f) The Student Nurse shall be personally responsible for any and all liabilities arising from
his/her gross negligence in the performance of his/her duties and functions while under training
with the affiliation center of the Institution;

g) The Parties shall not divulge any information that it may have access to and any such
information will only be used for academic purposes;

h) The Student Nurse shall be personally responsible for any and all liabilities, injury to
his/herself or to property or persons attributable to his/her own fault or negligence while in the
course of his/her training. In this light, the Student Nurse shall hold the /Institution or SWU
free and harmless from any demand, claim or complaint, whatsoever arising from this training
agreement, except in cases of gross negligence, malicious acts and criminal acts by any of the
officers, employees or agents of the Institution or SWU;

i) In the event that the Student Nurse materially violates any policy, the Affiliation Center shall
have the right to immediately, with due process, terminate the Related Learning Experience
(RLE) in relation to such Student Nurse by immediately serving a written notice to SWU;

j) The Student Nurse was made aware that he/she has the option not to join or participate in the
clerkship program amidst the ongoing pandemic and could have opted to wait until it is over or
already safe to do a face to face the Related Learning Experience (RLE), without any
additional penalty or extension;

k) Should any provision of this Agreement or part thereof is render void, illegal, or unenforceable
by any law to which it is subject of, it shall be rendered void, illegal, or unenforceable only to
that extent and not further. The invalidity or unenforceability of any provision of this
Agreement shall not affect or impair other provisions that are valid, binding, and enforceable.
 SECTION IV
Internship Program

a) The Student Nurse is expected to perform internship-related tasks such as, but not limited to,
research, production of written reports, attendance in didactics, examination and field-
activities, as may be applicable pursuant t the established Internship Program

b) The Student Nurse shall perform other tasks or responsibilities as reasonably directed by the
Institution in relation to the respective Related Learning Experience (RLE) established and

c) The Related Learning Experience (RLE) shall be deemed as an integral part of this
Agreement.

SECTION VI
Confidentiality and Waiver

a) It is expressly understood by the Student Nurse that all information on technology, process
standards, quality assurance methodologies, operational or technical manuals and other related
document that the SWU and the Affiliation Center shall be made for the sole purpose of
performing their tasks under the internship program.

b) It is understood that all information gathered by the Student Nurseon the operations and
business matters of the SWU and the Affiliation Center are classified as confidential in
nature. The Student Nurse hereby undertakes to prevent transfer of such information by any
of its members, consciously or unconsciously, to any party outside of the SWU and the
Affiliation Center without the latter’s knowledge and written consent.

c) That upon the termination of Related Learning Experience (RLE) from the SWU and the
Affiliation Center, the Student Nurse shall return all documents and property of the SWU
and the affiliation center, including but not necessarily limited to: reports, manuals and all
other materials and all copies thereof relating in any way to the SWU and the affiliation
centers, or in any way obtained during the course of Internship; and

d) The Student Nurse renounces and waives any claim against the SWU and the Affiliation
Center for any injury or loss that the Student Nurse may sustain or may suffer, personal or
financial, in the performance of his/her duties and functions while under training, unless such
is attributable to the negligence or fault of any of the employees, officers, or personnel of the
SWU and the Affiliation Center.

SECTION VII
Termination of the Agreement

The Parties shall have the right to pre-terminate the training contemplated by this
Agreement and the Related Learning Experience (RLE) by serving a written notice to the other
party at least thirty (30) days prior to the intended date of termination and based on the following
grounds:

a) The Student Nurse substantially violates the rules and regulations of SWU and the
Affiliation Center, or in cases of serious misconduct of the Student Nurse.

b) The SWU and the affiliation center is proven to fail in providing the safety of the
Student Nurse and quality of training contemplated by this Agreement and the
established Internship Program
 c) There is any material violation of the foregoing covenants that will warrant the
cancellation of this Agreement.

IN WITNESS WHEREOF, the parties have signed this Memorandum of Agreement at

the date and place above-stated.

SOUTWESTERN UNIVERSIY PHINMA

By:

MR. ALBERT L. GAMBOA

Executive Vice President/
Chief Operations Officer

DR. MICHELLE B. YU
Dean, College of Nursing ___________________________________
(Name of Student)
Student No.______________________
Course:

Signed In The Presence Of:

Parent/Guardian
(signature above printed name)

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in Cebu City, Philippines personally appeared the
following persons who presented to me their competent proof of identities as follows:

Name Proof of Issued at / Valid until

Identity

MR. ALBERT L. GAMBOA P2302542A DFA P2302542A DFA NCR NE / March 2022
DR. MICHELLE B. YU PRC No. November 14,2021
0366827

__________________________

known to me to be the same persons who executed the foregoing Agreement and acknowledge to
me that the same is their free and voluntary act and deed and that of the institutions they
respectively represent.

This instrument refers to a Memorandum of Agreement consisting of five (5) pages,

including this page whereon this Acknowledgement is written and signed by the parties and their
instrumental witnesses.

WITNESS MY HAND AND NOTARIAL SEAL, at the date and place first mentioned.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 20__.