University of Wisconsin-Stevens Point
Institutional Review Board for the Protection of Human Subjects
Request for Change(s) to a Full Board Approved Protocol
(For FULL BOARD Protocols Only)
Submit two (2) copies
The IRB requires that if you are making minor or major changes to your protocol after you
have obtained full board approval (within the first 12 months) that you submit the
following form.
Minor changes to protocols that do not increase the risk to participants (i.e. changes in
research team) do not require full board approval, but they do require the approval of the
IRB Chair, Dr. Debbie Palmer.
Major changes to the protocol that may change the risk to the participants (i.e. changes in
research procedures) require full board approval.
Principal Investigator(s)
Faculty Sponsor(s) (when appropriate)
Department/Division:
Title of Original Protocol
Date of Original Approval
Project Period: Starting Date:
Ending Date:
What is the current status of this research?
Ongoing data collection - Estimated completion date:
Ongoing (Data analysis or writing results only – Not enrolling new subjects)
Pending - Not yet started – Expected start date:
Please sign below and complete all of the questions on the next page. If you do not
properly complete and file this report, the IRB will not review or approve the changes to
your protocol.
(Signature of Principal Investigator(s))
(Signature of Faculty Sponsor if required)
****************************** Do not write below this line – for IRB use only ***********************
IRB approval
Date
(Signature of IRB Chair or Designee)
Revised 10/12/15
1. What changes are you proposing to your protocol? Please explain those changes here.
2. How will the changes potentially affect the risk(s) to individuals participating in this
research? What safeguards will you use to address the risk(s)?
3. Please attach a copy of your protocol application highlighting any changes since the last
approval.
Revised 10/12/15