Changes and/or Project Termination Form
Approved Research Involving Human Subjects
Research Compliance Services
Office of Research, Grants, and Contracts
The University of Tennessee at Martin
100 Hall Moody Administration Building
Martin, TN 38238
New Expiration Date
ORGC Approval
Initials
Notification of Change
Details of Changes Requested: (attach additional pages if more detail is required)
Change of Project Title
Change of Principal or Co-Principle Investigator(s), other Collaborators, Student Advisor
Change(s) to Project Which Affect Participation of Human Subjects
Change(s) in Informed Consent Form and/or Assent Form(s)
Additional Locations of Conducting Project
Unexpected Risks to Subjects
UTM-IRB Approval Needed for Another Year
Project Completed – Please Close IRB Files.
Project Title:
PLEASE CHECK THE APPROPRIATE LINE(S) BELOW (Consult IRB Guidelines):
Principal Investigator ________________________________ Date___________________
Faculty Advisor _____________________________________ Date___________________
(if required)
1.
2.
3.
4.
IRB number: Termination Date
PI Name:
PI Address:
