Affiliate On-Boarding Documents

The forms below are intended for use by MAHEC Affiliates prior to their start date. Affiliate relationships include, but are not limit to: students, learners, observers, contractors, or vendor representatives.

Please complete items 1, 2 and 3 shown below. Item 2 contains (2) separate articles that need to be completed. Item 4 is only required if Affiliate is under the age of 18. Once completed, submit to your MAHEC Host Representative directly.

  1. MAHEC Affiliate Application Packet
  2. Background Investigation documents — Please review and sign document A and complete article B.
    1. Criminal History Self Disclosure (signature required)
    2. Background Screening: Upon acceptance of your application, you will receive a background screening request from our provider "CRC" Criminal Record Check. Once completed, your MAHEC host will be notified.
  3. COVID-19 Screening Form - must be completed by all Affiliates at the time of onboarding.
  4. MAHEC Minor Consent and Release Form (Required only if under age 18)
  5. Affiliate COVID-19 Travel Form - to be completed every time the affiliate goes anywhere overnight and/or attends any gathering. 
  6. Request for Medical Exemption from Influenza Vaccination
  7. Request for Religious Exemption from Influenza Vaccination
  8. Authorization to Publish Photograph on MAHEC Sites
  9. Procedure for Drug-Screening Laboratory Information
  10. Consent and Notice of Release of Liability for Controlled Substance Testing
  11. N.C. Controller Substance Examination Regulation Act Initial Notice to Employees

If you are a health sciences student working with the Office of Regional Primary Care Education (ORPCE),
please email your completed forms to the ORPCE Program Coordinator at or call (828) 407-2599 to make other arrangements.

If you are affiliated with another program and have any questions about these forms, please contact your MAHEC Host Representative or Talent Management