Affiliation Agreement for Academic Institutions

Thank you for your interest in establishing an educational partnership with Covenant Health. Covenant is proud of its history in partnering with hundreds of academic institutions to further develop and grow our communities through on-site healthcare education! To formally establish this relationship, for on-site student learning at any of our many Covenant organizations, each academic institution must commit to one of the appropriate affiliation agreements found on this site.

Please complete the form below to receive the appropriate agreement for your institution. Each of these agreements is in a form document. Please fill out the gray-colored fields and have reviewed by the necessary officials at your institution. Ultimately, in order for the affiliation agreement to become valid, at least one original agreement must be signed by the institution’s representative as well as by Covenant’s Vice President of Learning and Leadership Development or the Senior Vice President / Chief Medical Officer for 3-way Affiliation Agreements. All 3-way Affiliation Agreements must include the supervising physician’s signature as well. Each agreement is in effect for a span of five (5) years.

For all 3-Way Affiliation Agreements, please contact Mary Long.

Mary Long, CPMSM
Covenant Health
280 Fort Sanders West Blvd., Bldg. 4, Suite 205
Knoxville, TN 37922
Phone: (865) 531-5336
Fax: (865) 531-5381

For all other agreements (High School, Public, and Private) – Final documents, along with any questions pertaining to the agreement, can be forwarded to the Learning & Leadership Development team. The contact information is below.

Learning & Leadership Development
Covenant Health
1400 Centerpoint Blvd.
Building A, Suite 101
Knoxville, TN 37932
Phone: (865) 374-8117
Fax: (865) 374-8124