Addendum Request Form
The Institutional Review Board (IRB) on the
Use of Human Subjects in Research
James Madison University
In accordance with federal regulations, the IRB must review and approve all changes to previously
approved research prior to implementation. Please complete this form to describe the proposed changes
to your study.
IRB Protocol #:
Project Title:
Name of Researcher(s):
Faculty Advisor (if applicable):
1. Provide an abstract of findings or summary of progress to date:
2. Type of addendum request:
Changes in personnel
Data collection tools/procedures
Project goals
Informed consent process/forms
Funding source
Subject recruitment methods/selection criteria
Other (please specify):
3. Provide a brief description of changes and rationale:
4. Attach amended material, as applicable (highlight all changes):
Certification:
I certify that the information supplied on this form and in accompanying attachments is complete and
accurate and that no procedures other than those disclosed on this form will be used in this protocol. I will
promptly report to the IRB all research-related accidents, injuries, complaints, problems, or breeches of
confidentiality. I will report any significant new findings that may affect the risks and benefits to the
subjects and other participants in writing to the research participants and to the IRB.
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Faculty Advisor Signature:
Date:
Submit electronic copy to researchintegrity@jmu.edu and a “signed” hard copy to the
Office of Research Integrity, MSC 5738
601 University Boulevard, Third Floor, Room # 342