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Martinsburg VA Medical Center

 

Colleges & Universities Information Page

 

Setting up an Affiliation Agreement with the VA Medical Center in Martinsburg:

Fill out the Pre-Affiliation Agreement and Contact the Affiliation Coordinators in the Education Department.

Residency Program:                

Kimberlee Chiavola

Affiliation Coordinato
Medical/Dental

Kimberlee.Chiavola@va.gov
304-263-0811, ext. 3620

Regina Jordan
Affiliation Coordinator
Associated Health
Regina.Jordan@va.gov
304-263-0811, ext. 4373

 

If you’re a College/University with a current Affiliation Agreement

You must complete ANNUALLY the:

Program Letter of Agreement and a

Trainee Qualification and Certification Verification Letter (TQCVL) This form must also be completed out of sequence if a student change is be made.

 

In addition to the above forms the Rotation Request forms below will need to be submitted

Individual Rotation Request Form

Group Rotation Request Form