Institutional Review Board (IRB)
Application for Amendment to a Previously Approved Protocol
For Investigations Involving Human Participants
Murray State University
It is the principal investigator’s responsibility to obtain IRB approval PRIOR to revising or altering the approved research protocol or Informed Consent documents IN ANY WAY. If the principal investigator is a student, it is the faculty sponsor’s responsibility to ensure that IRB written approval is obtained PRIOR to revising or altering the approved research protocol or Informed Consent documents. You must submit the signed form as a pdf document and the appropriate materials that support that request as Word documents to .
Principal Investigator’s Name:
Faculty Sponsor’s Name:
IRB Protocol Number:
Project Title:
Description of the change being requested to an approved protocol or informed consent document:
Reason for the change:
Please attach a copy of the current approved consent form. If you are requesting permission to alter this form, please attach a copy of the revised form that you wish to use with the requested changes highlighted on it.
You may not implement any changes to the approved protocol or informed consent documents without prior written approval of the IRB. You must submit this signed form and the appropriate supporting documents via email to .
Assurance Statement: I certify that to the best of my knowledge, the changes that I am requesting will not alter the risk/benefit ratio as presented in the originally approved protocol. If the changes that I am requesting will alter this ratio, I understand that I MUST resubmit the full protocol with the request for alteration or revision to the IRB for a complete review.
A. ______
Principal Investigator Date
Approval by faculty sponsor (required for all students):
I have read and do confirm the accuracy of this application, and I accept responsibility for the conduct of this activity.
B. ______
Faculty Sponsor Date