Modification Annual Review Research Termination Research Completion
ease complete the information below for our tracking purposes.
itle of Research Project: ________________________________________________________________
Previous/Current IRB Tracking # (if applicable) ______________
Principal Investigator:
Phone #:
culty Advisor (if applicable):
Phone #:
rovide the required information in the space available. If additional space is needed, attach a separate
sheet or expand that section of the form. Both scanned original signatures and typed electronic
signatures are acceptable.
Incomplete submissions will be returned to the applicant with review. All forms and research
instruments should be submitted by email to
This box is for SAU IRB Office Use Only
IRB Tracking #___________ Modification Annual Review Research Termination Research Completion
Date Received ____________ Exempt Expedited Full Review Animal/Plant
1) IRB Board Approver __________________________ _______________________ ______________
Name Title Date
2) IRB Board Approver __________________________ _______________________ ______________
Name Title Date
Date Approval Sent____________
Project Status: Please select the status of the project below:
Active Project ongoing.
No changes are planned and the project will continue as previously approved by the IRB.
Changes are planned. Please complete the section on page 2.
Project completed!
tification of Changes: Please check the appropriate boxes below and provide additional
information where appropriate (e.g. new title, new PI, description of changes, etc.) If no changes are
planned or project is completed, please leave blank.
Change to the project title, if different from your last approval letter, please provide new title:
Change(s) of principal or co-principal investigators(s), other collaborators, or change in faculty
advisor(s). Insert name changes here:
Changes(s) to project which will affect participation of human subjects. Revise and Amend any
relevant sections of Form A and submit these changes with a Form B. This requires a new Form A
as well as this Form B. Remember, there is no change too small to report to IRB.
Change(s) to informed consent forms and/or assent forms(s). Submit new consent Forms with a Form B.
Additional locations for conducting project. Submit with this Form B a copy of the letter(s) from these
organizations which have given permission for you to conduct your research in their institution. The
letters should be on the institution’s own letterhead. List the new locations where research is being
completed here:
Unexpected risks to subjects. If you have encountered unexpected risks to research
Subjects (e.g., breaches of confidentiality) or to yourself (e.g., angry parents, threats
of violence). Submit a copy of the Incident Report Form(s) with a Form B and describe how you have
or will resolve the problem:
Other changes: Please explain these changes here:
natures: If submitted by a faculty member, electronic (typed) signatures are acceptable. If submitted
by a student, please print out completed form, obtain the faculty advisor’s signature, scan completed
form, and submit it via e-mail. Only Word documents or PDF files are acceptable submissions.
cipal Investigator or Student Date
click to sign
click to edit
ty Advisor (if applicable) Date