Program Letter of Agreement Generator

The following questions are asked and then the form is completed automatically:

NOTE: Please complete the following information which will populate the form.
  • After the form is complete, please print it, get the Program Director and away site preceptor's signatures and forward to GME.
  • A complete PLA (including signatures of program director and away site director) must be received by GME in advance of the rotation start date:
    • 30 days for in-state rotations
    • 60 days for out-of-state rotations
    • 90 days for out-of-country rotations
Affiliation Site
Elective / Unique Activity A unique activity for an individual trainee. Please indicate the name of the resident/fellow(s), dates of the activity and the name of activity they will be scheduled on in MedHub.
Remuneration If this site is not a hospital, remuneration for preceptor must be negotiated. Please indicate type of remuneration:
Research activity - IRB If this is a research related activity, do you have IRB approval? (If yes, please send a copy of IRB approval letter to GME.)
For assistance, please contact the Graduate Medical Education Office at 503 494-8652.