Establishing a Professional Affiliate Policy - Northern Michigan University

Note:  The applicable form is attached as a word document.  

PURPOSE

Establish a process for approving a formal professional affiliation between Northern Michigan University (NMU) and an individual or a representative of an organization.

PROCEDURES

To initiate a Professional Affiliate designation, the following steps must be completed:

1. Offices, departments, and employees requesting a Professional Affiliate designation for a person or organization with no current NMU affiliation must complete the Professional Affiliate Request & Approval form.
2. The office manager, director, or department head must provide a rationale and specify the start and end dates for the Professional Affiliate designation in accordance with the Establishing a Professional Affiliate policy.
3. The desired privilege(s) requested for the Professional Affiliate must be clearly identified on the request form.  To receive these privileges the Professional Affiliate must also complete any necessary attendant forms.  The Professional Affiliate must read all NMU policy statements identified on the Professional Affiliate Request & Approval form (listed under References), and must agree to abide by these policies.  Professional Affiliate request forms must be signed by the NMU sponsoring office’s administrator and the individual to be designated as Professional Affiliate before being forwarded to the next administrative level.
4. The request must be approved by the appropriate NMU Vice President or by the President as stipulated in the Establishing a Professional Affiliate policy.
5. Upon approval, information regarding the individual receiving the Professional Affiliate designation will be entered into an NMU database.  Information in the database will include name, mailing address, and phone number of the Professional Affiliate.
6. A Professional Affiliate agreement may be renewed.  The Professional Affiliate Request & Approval form must be updated along with the database record indicating the revised designation end date.  Personal information regarding the individual should be updated as necessary. 

Upon approval, the completed Professional Affiliate Request & Approval form will be sent to Information Technology, with a copy to Human Resources, for processing. 

NOTE:  The following text matches the attached word document (which is a little lower on the form and called attached procedure file1).  If you need to print the form, use the word file attached further down on this page.    

NORTHERN MICHIGAN UNIVERSITY - PROFESSIONAL AFFILIATE - REQUEST & APPROVAL FORM

NOTE: All Individuals designated as Professional Affiliates must have a background check completed prior to the beginning of their relationship with Northern Michigan University. Please click here or visit https://nmu.edu/hr/hr-forms for instructions on how to initiate the background check request process. This form cannot be approved until the background check has been completed.

Professional Affiliate Information:

Last Name:  __________________    First Name: _____________________    MI: _________

Previous Last Name(s): _______________________________________________________

Street Address:  ____________________________________________________________  

City: _____________________    State: ______________ Zip Code: ___________________

Phone Number:  ______________________________   Type:      Mobile       Home       Work

Email Address: ___________________________________________________  

Organization/Institution Name: __________________________________________________

NMU Office/Department Seeking Approval for a Professional Affiliate:

Department/Office: __________________________________________________________ 

Campus Address & Phone Number: _____________________________________________

Administrator (e.g. Department Head, Director, Dean, Associate Vice President):

Last Name:  ______________________________ First Name: ________________________

Position: ___________________________________________________________________

Campus Phone Number:  _____________________________________  

NMU Email Address:  _________________________________________

Purpose of the Professional Affiliation:

__________________________________________________________________________

Start date: ______________       End date (no greater than 3 years): _________________                                            

Privileges Requested for Professional Affiliate (include rationale for each request)

NMU Computer Network User ID                 Yes ___  No ___

              Rationale: _________________________________________________________

NMU Photo ID Card                                       Yes ___  No ___

              Rationale: __________________________________________________________

Parking                                                            Yes ___  No ___                

              Rationale: __________________________________________________________

Required Signatures

Individual receiving a Professional Affiliate designation:  I attest that I have read all of the NMU Policy Statements identified as “References” on the Professional Affiliate Request & Approval form, and I agree to abide by the rules and regulations described.

Professional Affiliate:  ____________________________       Date:  ____________

Please approve only after receiving confirmation of the successful completion of the background check.

Department Head/Director, Dean, Associate Vice President: I agree to ensure that the Professional Affiliate is aware of applicable policies regarding the use of NMU resources.

Department Head/Director:

_____________________________________________________ Date: ______________

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College Dean or Senior Management:

__________________________________________________        Date:  ______________

APPROVAL

Executive Administrator (Vice President or President):

______________________________________________         Date:  ____________

REFERENCES

• NMU Acceptable Use Policy
• NMU Background Check Policy
• NMU Password Policy
• NMU Intellectual Property Policy
• NMU Motor Vehicle Ordinances

ACKNOWLEDGMENT

I understand that by accepting Professional Affiliate designation at Northern Michigan University I am merely being given access to specific, limited NMU resources (e.g. network access, parking) to aid my professional association with NMU.  Except for such resources, I recognize that I am entitled only to the same rights and protections as any other visitor to NMU’s campus.

Recognizing that NMU is not my employer, I acknowledge and understand that I will not be paid wages by NMU.  I recognize and acknowledge that if I become ill or am injured while engaged in the professional affiliate activities, while utilizing NMU’s resources, or while on NMU’s property, that NMU provides no remedy.

I take full responsibility for my actions and/or behaviors while using NMU’s resources or while on NMU property.  I understand that my “privileges” are limited to those identified in the Professional Affiliate Request & Approval form, that I am entitled to use only those NMU resources identified in the Professional Affiliate Request & Approval form, and that I will abide by the Policy Statements listed on the Professional Affiliate Request & Approval form.  I specifically understand that NMU’s responsibility and/or liability for my actions and safety while on NMU property is no greater or different than NMU’s responsibility and/or liability to any other campus visitor.

I recognize and understand that NMU can discontinue my Professional Affiliate designation at any time and for any reason. 

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Print Name   

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Signature                                                                

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Date