VA Form 10-9054: UME Medical Education Affiliation Agreement

VA Form 10-9054: UME Medical Education Affiliation Agreement – The Department of Veterans Affairs (VA) partners with medical schools across the United States to train the next generation of physicians through structured affiliation agreements. VA Form 10-9054 formalizes these partnerships specifically for institutions offering Undergraduate Medical Education (UME) programs, including allopathic and osteopathic medical schools.

This comprehensive article explains the form’s purpose, who uses it, key responsibilities, and how to access the latest version. Medical school administrators, VA facility leaders, and academic affairs professionals in the U.S. will find this resource valuable.

What Is VA Form 10-9054?

VA Form 10-9054 is the official Medical Education Affiliation Agreement Between VA and Institutions with Undergraduate Medical Education (UME). It establishes a formal partnership between a VA medical center and a medical school (allopathic or osteopathic) for the education of medical students.

The form outlines shared responsibilities for providing high-quality clinical training while ensuring patient safety and compliance with accreditation standards. It supports VA’s statutory mission under 38 U.S.C. Section 7302 to develop and train health care professionals.

The current version (August 2018) is an 8-page fillable PDF designed for execution by authorized representatives of both the VA facility and the partnering institution.

Purpose and Background of the UME Affiliation Agreement

The primary purpose of VA Form 10-9054 is to create a collaborative framework that benefits Veterans, medical students, and the broader U.S. health care system. Key objectives include:

  • Enhancing patient care through academic partnerships
  • Providing clinical training opportunities for medical students
  • Maintaining accreditation compliance for both VA facilities and medical schools
  • Promoting mutual resource sharing and avoiding duplication of efforts
  • Supporting workforce development for future health care providers

The agreement emphasizes that the affiliated medical school holds primary responsibility for the educational program, while the VA medical center retains full authority over patient care and facility operations. This balance ensures safe, effective training environments.

Who Should Use VA Form 10-9054?

This form is intended for:

  • VA Medical Centers seeking to affiliate with medical schools for undergraduate medical education rotations
  • Allopathic (MD) and Osteopathic (DO) Medical Schools accredited by the Liaison Committee on Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA)
  • Academic Administrators and Designated Education Officers (DEOs) involved in clinical training partnerships

It applies specifically to UME (medical student) programs and differs from forms used for Graduate Medical Education (GME) or other health professions.

Key Responsibilities Outlined in VA Form 10-9054

The agreement details mutual and specific responsibilities for both parties.

Institution (Medical School) Responsibilities

  • Maintain LCME or COCA accreditation and notify VA of any changes
  • Appoint and assign qualified faculty for teaching
  • Oversee curricula, student selection, assignments, and evaluations
  • Complete Trainee Qualifications and Credentials Verification Letters (TQCVLs)
  • Ensure students have required immunizations and background checks
  • Provide access to curricular materials and support faculty development

VA Medical Center Responsibilities

  • Maintain facility accreditation (e.g., The Joint Commission)
  • Appoint qualified supervisors and site directors
  • Provide appropriate learning environments and resources
  • Orient trainees to VA policies, including Mandatory Training for Trainees (MTT)
  • Evaluate student performance in consultation with the institution
  • Ensure compliance with VA handbooks and directives (1400 series)

Both parties collaborate on faculty appointments, committee participation, and maintaining a safe learning environment that prioritizes patient care and trainee well-being.

How to Complete and Submit VA Form 10-9054?

  1. Download the official fillable PDF from the VA website.
  2. Complete facility, network, institution, and accrediting body information.
  3. Review and agree to all terms regarding responsibilities, accreditation, supervision, and policies.
  4. Obtain signatures from authorized representatives.
  5. Secure VA approval as required.

The agreement becomes effective once duly executed and approved by the Department of Veterans Affairs. It forms the foundation for more specific Program Letters of Agreement (PLAs) for individual rotations.

Download VA Form 10-9054 Here:
Download VA Form 10-9054 (PDF)

Official VA Form Page:
VA Form 10-9054 Information

Benefits of VA-Medical School Affiliations

These partnerships provide medical students with valuable exposure to Veteran-specific health issues, interdisciplinary care models, and federal health systems. VA facilities gain access to academic resources, while medical schools expand clinical training capacity. The agreements support VA’s role as a major contributor to U.S. medical education.

For GME programs, refer to VA Form 10-9055. Additional guidance is available through the VA Office of Academic Affiliations. Always verify the latest forms and policies on official VA.gov pages, as requirements can be updated.

Medical schools and VA facilities should consult legal and academic affairs teams when negotiating or renewing affiliations.

This article is for informational purposes only and is based on publicly available VA resources as of 2026. Consult official VA channels or legal counsel for specific guidance.