PURDUE UNIVERSITY
Institutional Biosafety Committee
Request for Amendment to Approved Protocol
[Please Print or Type]
IBC Approved Protocol Ref. #:
Title:
P.I.:
Dept./Bldg.:
Change In: Use of Biohazardous Agents; and/or
Use of Unfixed Human fluid or tissue; and/or Use of rDNA
DETAILS/EXPLANATION (Continue on extra pages, as needed):
SIGNATURE OF PI: _______________________________________________
DATE: ____________

This protocol meets regulatory facility and training requirements.
Robert W. Golden, Biosafety Officer
Date
Following review by the Purdue University IBC of the proposed research, this protocol is:
( ) Approved
( ) Not approved
( ) Approval not required (Exempt)
Additional conditions:
Notify the IBC when the experiment is initiated.
IBC/NIH/OBA/CDC approval needed before starting the experiment.
IBC/NIH/OBA/RAC approval needed before starting the experiment.
Other:
Steven S. Broyles, Chair, IBC
Date
Cc: <P.I.>
<Dept Head>
Ms. Ianthe Bryant-Gawthrop/AVPR/HOVD
IBC Form 2A [January 22, 2002]