Modification Request Form

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Institutional Review Board
FWA00003873
Request for Modification of Human Subjects Research Protocol
Protocol Information
Investigator(s):
Project Title:
Protocol #:
Modification Description
Will there be a change of Principal Investigator or a change in or addition to other project staff?
No
Yes (please attach CITI training completion reports for new personnel)
If yes, please explain and list new personnel and their role in the study:
Are there planned changes in your research activities?
No
Yes
If yes, please explain:
Will your Informed Consent form be revised?
No
Yes
If yes, please attach a copy of the new form.
Submit forms via email to [email protected] Please copy your faculty sponsor if you are a
student investigator.
Your electronic submission of this form certifies that the planned changes in the study will not adversely
affect the human subjects and that the use of human subjects is in accordance with federal and
University regulations. Any additional proposed modifications in the research activities must be
presented to the IRB for approval prior to implementation.
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