Mid Month Departmental Submission

IRB Project Amendment Form
Thank you for taking the time to engage with Mid Michigan College's Institutional Review Board (IRB). The IRB is responsible for reviewing all research projects submitted by College personnel to ensure the protection of human subjects' rights and welfare, and ensures that risks related to research are assessed and minimized, potential benefits are identified, participation is voluntary as demonstrated by informed consent, and confidential information is safeguarded.

Use this form to describe and justify a change to project protocol after initial IRB approval.

Questions? Email ir@midmich.edu for guidance.

Project Information

Welcome! Let's begin with some basic information.
Enter the title of your research project.*
Provide the title of your research project.
Enter the IRB Reference Number of your research project.*
This number is typically a TBD digit number in the following structure TBD.
What is the name of the Principal Investigator (PI)? This must be a Mid Michigan College faculty or staff member.*

First NameLast Name
What is the Mid Mich Email of the PI?*
example@midmich.edu
What is the Phone Number where the PI can be reached?*

Area CodePhone Number
Does your research project have a Secondary Investigator (SI)?*

YesNo
What is the name of the Secondary Investigator (SI)?*

First NameLast Name
What is the Email of the SI?*
example@example.com
What is the Phone Number where the SI can be reached?*

Area CodePhone Number

Let's learn more about your research project.

Share key information with us regarding the proposed changes to your project.
Provide a detailed summary of the proposed modifications to the project.*
Include specifics about what changes are being requested (e.g. procedures, population, consent process).
Explain the reasons why these changes are necessary.*
Discuss both scientific and ethical justifications.
Describe any expected impact on current or future participants.*
Include changes to risk levels, benefits, or the consent process.
Explain how the changes may affect project design, data integrity, or project outcomes.*
Include any anticipated challenges or improvements.
Are there are any changes to the informed consent form?*

YesNo
Explain the changes to the informed consent form.*
Be as detailed as possible.
Upload the revised informed consent form for review.*

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List any other documents that have been updated.*
Include any document that has been revised since initial IRB approval (e.g. protocol, recruitment materials).
Upload any other documents that have been updated.*

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Use this space to add any information or context that supports the amendment request.
You might include any issues this may resolve or improvements the amendment may lead to.

My signature below certifies that the information above is accurate and corresponds to the research project referenced. All necessary supporting documentation is attached.
Signature of the Principal Investigator*

Clear
Date*

MonthDayYear
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IRB Project Amendment Form