C. Offer all unsuccessful applicants employed by Facility one additional opportunity to retake an exam, at no additional cost, per Contract Period.

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1 MSNCB FailSafe Certification Program CONTRACT: This Contract, made this day of, 20, between the Medical-Surgical Nursing Certification Board (hereafter referred to as MSNCB ) and, a health care facility in,, hereafter referred to as Facility. MSNCB and Facility are referred to collectively as the Parties. Responsibilities of the Parties: I. Facility agrees to: A. Enroll a minimum of ten (10) eligible registered nurses as applicants for MSNCB administered certification exams, the Certified Medical-Surgical Registered Nurse (CMSRN ) exam or the Certified in Care Coordination and Transition Management (CCCTM) exam for the twelve (12) month period of this Contract, hereafter referred to as Contract Period. If Facility is unable to meet the terms of this Contract by enrolling 10 applicants to take the exam, MSNCB will invoice Facility for all exams taken regardless of a pass or fail outcome. B. Identify a contact person(s) for this program to assist MSNCB in managing and recruiting eligible registered nurses for any MSNCB exam. The contact person will maintain contact with MSNCB staff to ensure that the minimum number of registered nurses is recruited for any MSNCB exam within the Contract Period. Contact persons are named in Addendum 1. C. Pay MSNCB the appropriate fee of either a designated member fee of two hundred fiftyfive dollars ($255.00) or the non-member fee of three hundred seventy-five dollars ($375.00), for each Facility-employed registered nurse who passes an MSNCB exam. D. Pay the application fee for each Facility-employed registered nurse who applies for an MSNCB exam and neglects to take the exam without due cause and supporting documentation. Supporting documentation must be submitted to and approved by MSNCB within 10 days of the missed exam appointment or permit expiration date, whichever occurs first, for the Facility not to incur a charge for said registered nurse. E. Pay MSNCB s invoices within thirty (30) days of receipt. II. MSNCB agrees to: A. Assist Facility in recruitment of applicants, as follows: 1. Provide Facility with exam recruitment materials at no cost to the Facility. 2. Assist Facility contact person in monitoring applications. 3. Provide the contact person with a monthly report of all applications received. B. Allow enrolled Facility applicants to take an MSNCB exam. All applicants will complete a certification exam application and submit to MSNCB. A nurse who registers for but does not take the exam within the allotted time period for any reason will forfeit one opportunity to take the exam. C. Offer all unsuccessful applicants employed by Facility one additional opportunity to retake an exam, at no additional cost, per Contract Period. D. Provide Facility with a detailed monthly invoice listing all registered nurses who have successfully passed or neglected to take any MSNCB exam(s) and the appropriate fees. E. Upon request, provide Facility with an annual customized exam performance report which lists an aggregate profile of candidates exam performance in all content areas.

2 F. Allow enrolled Facility the opportunity to host the Academy of Medical-Surgical Nurses (AMSN) Medical-Surgical Nursing Certification Review Course On-the-Road at a $1,000 discount off the course fee during the Contract Period. III. Additional Terms: A. Except as otherwise stated in this Contract, each party agrees not to use the name, trademark, service mark, or design registered to the other party or its affiliates in any publicity, promotional, or advertising material, unless review and written approval of the intended use is obtained from the other party prior to the release of any such material. IV. Term, Termination and Renewal: A. This Contract is for one year, beginning, 20 and terminating 12 months thereafter. B. Automatic Renewal: Unless either party to this Contract provides written notice to the other sixty (60) days prior to expiration of the Contract Period, this Contract shall automatically renew for successive one (1) year Contract Periods. C. This Contract may be terminated under the following conditions: 1. The Facility ceases operations as a health care facility. 2. MSNCB ceases business as a certification board. 3. The facility fails to meet the minimum enrollment terms of this Contract for two consecutive Contract Periods. 4. Either party may terminate this Contract for cause upon 60 days written notice to the other party. 5. In the event of termination, Facility shall remit payment of any monies due within thirty (30) days of invoice date. D. Notice of termination or change should be sent to: For Facility: V. Entire Agreement: For MSNCB: Terri Hinkley, MBA, BSN, RN, CCRC Chief Executive Officer Medical-Surgical Nursing Certification Board East Holly Avenue Box 56 Pitman, NJ Phone: Fax: msncb@msncb.org A. This Contract constitutes the sole and entire agreement between the Parties and supersedes any prior understanding of written or oral agreements between the Parties respecting the subject matter. No amendment or alteration of the terms of this agreement will be binding unless in writing signed by all Parties.

3 IN WITNESS WHEREOF, the Parties hereto, being duly authorized, have executed this Contract effective as of the day and year written above. For Facility: Signature Date For MSNCB: Terri Hinkley, MBA, BSN, RN, CCRC Chief Executive Officer Signature Date

4 ADDENDUM 1 For the purposes of this Contract, the following health care Facility staff will work with MSNCB to complete the responsibilities outlined in this Contract: Facility Contact Person for the MSNCB FailSafe Certification Program (e.g., Clinical Educator, Magnet Program Director, Staff Development Manager) This person receives the code to disseminate to eligible registered nurses to use when registering for an MSNCB exam. May have more than one contact. Phone Address 1 Address 2 City ST Zip Facility Contact Person for invoicing This person receives the invoices and facilitates payment to MSNCB within thirty (30) days of receipt. May be the same person as the Facility contact listed above. Phone

5 Billing Address 1 Billing Address 2 City ST Zip MSNCB Staff for the MSNCB FailSafe Certification Program: Patricia Esola Certification Services Coordinator patricia.esola@msncb.org MSNCB, East Holly Avenue Box 56, Pitman NJ 08071

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