The University of Toledo
Department for Human Research Protections
Social, Behavioral & Educational IRB
Phone: 419-530-2844 Fax: 419-530-2841
Biomedical Institutional Review Board
Phone: 419-383-6796 Fax: 419-383-3248
(FWA 00010686)
ATTACHMENT D.
Informed Consent /
Assent Authorization
Form
UT Reference #
For IRB office use.
PLEASE INCLUDE THE FOLLOWING:
 A copy of the CURRENT IRB APPROVED form(s)
 An updated version showing the TRACKED CHANGES
 The Proposed form(s) in a CLEAN COPY format ready for the IRB Approval stamp.
Principal Investigators must complete and submit the Change Request Cover Sheet with this attachment.
Type of
Change
Current
Approved
Version Date:
Update/Change
Version Date:
Describe Change Requested:
All changes/updates must be identified in the
Consent/Assent/Authorization Form itself, additional
information may be attached to this form if necessary.
Rationale for Change:
Consent and/or
Authorization
Form
Consent and/or
Assent Form
Misc.
Addendum
Attachment D. Informed Consent or Assent Changes
Version 08/2007
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