Wichita State University Institutional Review Board (IRB)
RTT February 2018
Application for Amendment
A study must be carried out in accordance with the application approved by the IRB. Any changes to the study, including
but not limited to changes in the subject population, recruitment plans, advertising materials, research procedures, survey
instruments, consent forms, sites or research personnel who are instrumental to the design or execution of the study must
be approved by the IRB prior to the change taking place.
IRB Number:
Title:
Name of Principal Investigator(s):
E-Mail Address: Campus Box: Phone:
Department/Program Affiliation:
Name(s) current of Co-Investigator(s):
Have all listed study personnel completed CITI Human Subjects Training? Yes No
Please select ALL categories of amendment(s) in which you are requesting.
Changes in currently approved application
Changes in currently approved consent form or procedures – please attach revised documents and highlight
changes or use tracked changes
Changes to or Addition of survey(s), questionnaire(s), or other research instruments – please attach the
revised or new instruments and highlight changes or use tracked changes
Change in Study Title
Change in Principal Investigator – have both current and newly proposed PI sign this document
Addition/deletion of research personnel – for new personnel list their role on the project on page 2
Change to research study design, methods or procedures (e.g., observations, interventions, collection of
biological samples or biometrics information, participant tasks, etc.)
Addition/deletion of a site
Addition of/change to study population
Addition of/change to recruitment or compensation procedure(s)
Addition of change to the identifiers collected in the study, or any others that would impact the privacy and
confidentiality of the study participants
Other changes (explain on page 2)
