Fillable SMUREB Form2 (St. Mary's University)

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SMUREB Form2 (St. Mary's University)

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FOR OFFICE USE ONLY
SMU REB #:
DATE RECEIVED:
Form 2- Faculty/Student/Staff
Form 2 is submitted to request alterations to the protocol, study documents/materials and administrative updates.
Revised methods may not be implemented until ethics approval has been confirmed.
INSTRUCTIONS: Send request to ethics.continuingreview@smu.ca (only)
Electronic submission directive:
1) Please send Form 2 along applicable documents needing approval, with all changes highlighted, to
ethics.continuingreview@smu.ca (only);
2) Requests involving student protocols must be submitted by the Faculty Supervisor;
3) Original signature is not required for electronic submissions;
4) It is required that all fields be completed.
5) Incomplete submissions will not be processed and will be returned to sender.
1. TITLE OF RESEARCH PROJECT
MODIFICATION REQUEST FORM
a) SMU REB File #:
Choose one
Type of Research:
Choose one
b) Title of Research:
2. STUDY STATUS
a) Does this study hold current REB approval?
Yes
No
If no, submit an ANNUAL RENEWAL REQUEST FORM 3 along this request.
b) Current Approval Period:
From: (dd/mmm/yyyy)
To: (dd/mmm/yyyy)
c) If applicable, for multi-jurisdictional research, other relevant REB approval is attached.
Yes
N/A
d) What is the current study status of the study?
No recruitment to date
Active recruitment
Active participation
Recruitment ended
Participation ended
On hold
Analysis
Final Analysis
Secondary data only
Other:
3. INVESTIGATOR CONTACTS
For Student research, begin with listing the Faculty Supervisor. For Faculty and Staff research, begin with listing the Faculty/Staff Principal Investigator.
a) Role:
Choose one
Name:
Phone #:
Email:
b) Role:
Choose one
Name:
Phone #:
Email:
c) Role:
Choose one
Name:
Phone #:
Email:
Page 1 of 3
4. MODIFICATION REQUEST
Report changes to: (check all that apply)
a) protocol;
b) consent form/script;
c) supporting study documents;
d) administrative changes (such as: new research staff, new contact details, change to the study title, etc.);
e) changes to funding details;
f) other
g) Provide a brief description of and explanation for any modifications requested to your previously approved application.
If these changes are to a questionnaire, interview protocol, information letter, consent form/script form with previous
ethics approval, submit the entire document and highlight the sections that are revised or added. A complete copy of
any new measures or scales must be attached for ethics review.
Page 2 of 3
5. AGREEMENT
I have read the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2), Saint Mary's University
REB Procedures for Completing Requests for Ethics Review and the Senate Policy on Ethical Conduct for Research Involving
Humans and agree to comply with the policies and procedures outlined therein. In the case of student research, as faculty
supervisor, my signature indicates that I have read and approved the request, deem the project scientifically valid and agree to
provide continuing and thorough supervision of the student(s). I will ensure that the level of risk inherent to the project is managed
by the level of research experience that the student investigator has combined with an extent of oversight that will be provided by
me and that the research will be conducted in accordance with the SMU REB's appoved protocol, and consenting process.
FACULTY SUPERVISOR
_____________________________
Signature of Faculty Supervisor
(Type name)
Date (dd/mmm/yyyy)
PRINCIPAL INVESTIGATOR
_____________________________
Signature of
Choose role
(Type name)
Date (dd/mmm/yyyy)
CO-INVESTIGATOR
_____________________________
Signature of
Choose role
(Type name)
Date (dd/mmm/yyyy)
_____________________________
Signature of
Choose role
(Type name)
Date (dd/mmm/yyyy)
_____________________________
Signature of
Choose role
(Type name)
Date (dd/mmm/yyyy)
_____________________________
Signature of
Choose role
(Type name)
Date (dd/mmm/yyyy)
Page 3 of 3
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SMUREB Form2 (St. Mary's University)

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Completed 21 July 2020

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